Change Theory Contributes to Choosing Wisely for Immune Thrombocytopenia.
Hosp Pediatr
; 9(3): 156-161, 2019 03.
Article
en En
| MEDLINE
| ID: mdl-30808652
ABSTRACT
OBJECTIVES:
Despite 2011 guidelines in which it is suggested that treatment of acute immune thrombocytopenia purpura (aITP) is not needed for patients without significant bleeding, only 14% of children treated for aITP have bleeding symptoms. Our aim was to decrease the percentage of children with first-episode aITP who were unnecessarily treated by 50% within 12 months of guideline implementation.METHODS:
An intervention was designed by using the precaution-adoption-process model. A standard-of-practice meeting was organized and focused on clinician readiness for change. After education on current evidence and common cognitive errors, consensus clinical guidelines were created. After implementation, an article in a statewide professional newsletter was published to educate community providers. Unnecessary treatment (UT) was defined as treatment of any patient who only had bruising and/or self-resolving nose bleeds. Statistical process control charts were used to track progress, midline shifts were determined by Nelson's rules, and hospital costs were derived from administrative billing data.RESULTS:
One hundred children with aITP were seen from January 2013 to September 2018. UT decreased from 70% to a sustained rate of <30% (P = .008), including a mean of 7% over the past 12 months. The admission rate decreased from 100% to 52% (P = .013), and the total percentage of patients treated decreased from 100% to 48% (P = .016), with both numbers continuing to decline. No adverse bleeding events occurred. An estimated 12 admissions, 4 readmissions, and 5 adverse events were avoided annually.CONCLUSIONS:
We demonstrated successful improvement in UT of aITP through an educational intervention informed by the precaution-adoption-process model change theory.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Púrpura Trombocitopénica Idiopática
/
Educación Médica Continua
Tipo de estudio:
Diagnostic_studies
/
Guideline
/
Prognostic_studies
Límite:
Child
/
Humans
Idioma:
En
Revista:
Hosp Pediatr
Año:
2019
Tipo del documento:
Article