文章基本信息

标题：De-implementation of inappropriately tight control (of hypoglycemia) for health: protocol with an example of a research grant application
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作者：David C Aron ; Julie Lowery ; Chin-lin Tseng 等
期刊名称：Implementation Science
印刷版ISSN：1748-5908
电子版ISSN：1748-5908
出版年度：2014
卷号：9
期号：1
页码：58
DOI：10.1186/1748-5908-9-58
语种：English
出版社：BioMed Central
摘要：Implementation of practice change is difficult and large scale implementation is particularly difficult. Among the challenges facing the healthcare system in general and healthcare organizations is the overuse of low value care. Improving medication safety also constitutes an attempt to reduce low value or potentially harmful care. Critical issues of overuse of low value practices and medication safety intersect in overtreatment of diabetes. Specifically, (over)intensive glycemic control increases hypoglycemia risk and morbidity without providing meaningful benefit. Our work indicates that among patients with diabetes who are at high risk for hypoglycemia, potential overtreatment is common. The Choosing Wisely Initiative to reduce low value care led by the American Board of Internal Medicine Foundation recommends not to treat most persons over 65 years of age with medications to reduce the A1c 9%), we will also assess undertreatment. We will take advantage of a natural experiment and use a Type III Hybrid Design that focuses on study of implementation while at the same time observing and gathering information on clinical interventions and outcomes. This mixed methods study will use longitudinal data and qualitative methods including Qualitative Comparative Analyses. Our multi-paradigm approach to examining potential mechanisms to explain the variation in reduction of rates of overtreatment will contribute to a better understanding of implementation of national dissemination projects and multi-component interventions in complex systems.
关键词：Hypoglycemia ; Safety Culture ; Grant Application ; Qualitative Comparative Analysis ; Intensive Glycemic Control