Document text
Principal Investigator: Deepika Mohan
Organization: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
Fiscal Year: 2024
Award: $594,828
Funding agency: National Institute on Aging
PROJECT ABSTRACT
Injury is the leading cause of loss of independence among those over the age 65, resulting in over 3 million
Emergency Department (ED) visits, 800,000 hospitalizations, and greater than $50 billion in costs each year.
Guideline-concordant triage of trauma patients – rapid identification of those with severe injuries and transfer to
trauma centers – decreases mortality by 10 to 25%, reduces loss of independence, and diminishes pain at one
year. Despite this evidence, however, under-triage persists (incidence: 50%), particularly among those over the
age of 65 (incidence: 80%). To address this implementation gap, we propose to conduct a Type I hybrid
effectiveness-implementation trial in which we test the effect of video game-based training on physician
behavior. We designed this trial based on extensive preliminary studies, during which we isolated physician
behavior as the single largest source of variation in triage practices, identified heuristics (pattern recognition)
as a major cause of behavior, developed theory-based, customized video games to recalibrate physician
heuristics (i.e., align them with clinical practice guidelines), and ensured their efficacy in the laboratory. For this
trial, we will recruit a national sample of emergency medicine physicians (n=900), in collaboration with three
large staffing organizations, and will randomize physicians to one of three interventions: video game-based
training, text-based education (active control), or nothing (passive control). The specific aims of the trial are (1)
to test the effect of the three interventions on behavioral (e.g., under-triage) and patient-centered outcomes
(e.g., 30-day mortality) by linking trial data to Medicare claims, (2) to compare the mechanisms of action by
which the active interventions affect physician behavior by using a suite of validated instruments, and (3) to
identify contextual factors that influence implementation and maintenance of guidelines in practice by
performing a comprehensive qualitative evaluation of trial participants (n=20) and a national sample of key
decision makers (e.g., ED directors, patients [n=20/group]). Together these aims will provide critical insight into
the effectiveness of our novel intervention and key data to inform future implementation efforts.
Terms: <65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><Academy><Accident and Emergency department><Active Follow-up><Address><Affect><Aged 65 and Over><Aging><Agreement><Application Context><Behavior><Behavior assessment><Behavioral><Behavioral Sciences><Calibration><Caring><Clinical Practice Guideline><Clinical Sciences><Collaborations><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Cues><Data><Decision Making><Detection><Development><ED Physician><ED visit><ER physician><ER visit><Education><Educational aspects><Effectiveness><Emergency Department><Emergency Department Physician><Emergency Medicine><Emergency Physician><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room><Emergency room physician><Emergency room visit><Ensure><Evidence based intervention><Evidence based practice><Expenditure><Exposure to><Failure><Feedback><Goals><Guidelines><Health><Hospital Admission><Hospitalization><Hour><Incidence><Independent Living><Injury><Intervention><Intervention Strategies><Interview><Intuition><Judgment><Laboratories><Link><Literature><Maintenance><Medical><Medicare claim><Medicine><Methods><Morbidity><Morbidity - disease rate><Pain><Painful><Paramedic><Paramedical Personnel><Participant><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Pattern Recognition><Persons><Physicians><Play><Power Sources><Power Supplies><Qualitative Evaluations><RE-AIM><Randomized><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Refractory><Reporting><Research><Research Priority><Sampling><Scientist><Source><Structure><Testing><Text><Time><Training><Trauma><Trauma patient><Triage><Uncertainty><Variant><Variation><Video Games><Work><above age 65><active control><active followup><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><behavior change><behavioral assessment><care as usual><clinical implementation><clinical practice and guidelines><clinician behavior><cognitive process><compare effectiveness><compare intervention><comparison intervention><contextual factors><continuing medical education><cost><critical injury><devastating injury><developmental><doubt><effectiveness and implementation trial><effectiveness/implementation hybrid study><effectiveness/implementation hybrid trial><effectiveness/implementation study><effectiveness/implementation trial><experience><follow up><follow-up><followed up><followup><future implementation><heuristics><hospital re-admission><hospital readmission><human old age (65+)><implementation efforts><implementation science><improved><improved outcome><injuries><injury burden><insight><instrument><intervention design><intervention effect><interventional strategy><intuitive><mortality><multidisciplinary><novel><old age><older adult><older adulthood><outreach><over 65 years><patient oriented outcomes><physician behavior><pilot trial><pressure><preventable death><preventable mortality><programs><provider behavior><randomisation><randomization><randomly assigned><re-admission><re-hospitalization><reach, efficacy, adoption, implementation, and maintenance><readmission><recruit><rehospitalization><severe injury><simulated virtual reality><theories><therapy design><trauma centers><treatment as usual><treatment design><trial design><usual care><videogame><videogame intervention><virtual reality simulation><virtual simulation><≥65 years>