Johnson David W, Craig William, Brant Rollin, Mitton Craig, Svenson Larry, Klassen Terry P
Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary Alberta, Canada.
Implement Sci. 2006 Apr 28;1:10. doi: 10.1186/1748-5908-1-10.
The optimal management of croup--a common respiratory illness in young children--is well established. In particular, treatment with corticosteroids has been shown to significantly reduce the rate and duration of intubation, hospitalization, and return to care for on-going croup symptoms. Furthermore treatment with a single dose of corticosteroids does not appear to result in any significant adverse outcomes, and yields overall cost-savings for both families and the health care system. However, as has been shown with many other diseases, there is a significant gap between what we know and what we do. The overall aim of this study is to identify, from a societal perspective, the costs and associated benefits of three strategies for implementing a practice guideline that addresses the management of croup.
METHODS/DESIGNS: We propose to use a matched pair cluster trial in 24 Alberta hospitals randomized into three intervention groups. We will use mixed methods to assess outcomes including linkage and analysis of administrative databases obtained from Alberta Health and Wellness, retrospective medical chart audit, and prospective telephone surveys of the parents of children diagnosed to have croup. The intervention strategies to be compared will be mailing of printed educational materials (low intensity intervention), mailing plus a combination of interactive educational meetings, educational outreach visits, and reminders (intermediate intensity intervention), and a combination of mailing, interactive sessions, outreach visits, reminders plus identification of local opinion leaders and establishment of local consensus processes (high intensity intervention). The primary objective is to determine which of the three intervention strategies are most effective at lowering the rate of hospital days per 1,000 disease episodes. Secondary objectives are to determine which of the three dissemination strategies are most effective at increasing the use of therapies of known benefit. An economic analysis will be conducted to determine which of the three intervention strategies will most effectively reduce total societal costs including all health care costs, costs borne by the family, and costs stemming from the strategies for disseminating guidelines.
小儿喉炎是幼儿常见的呼吸道疾病，其最佳治疗方案已确立。尤其是，使用皮质类固醇进行治疗已被证明能显著降低插管率、住院时间以及因持续的喉炎症状而复诊的次数。此外，单剂量皮质类固醇治疗似乎不会导致任何显著的不良后果，并且能为家庭和医疗保健系统节省总体成本。然而，正如许多其他疾病所显示的那样，我们所知道的与我们所做的之间存在显著差距。本研究的总体目标是从社会角度确定实施一项针对喉炎管理的实践指南的三种策略的成本及相关效益。
方法/设计：我们建议在艾伯塔省的24家医院进行配对整群试验，将这些医院随机分为三个干预组。我们将使用混合方法评估结果，包括链接和分析从艾伯塔省健康与福利部获得的行政数据库、回顾性病历审核以及对被诊断患有喉炎的儿童家长进行前瞻性电话调查。将要比较的干预策略包括邮寄印刷教育材料（低强度干预）、邮寄加上互动教育会议、教育外展访问和提醒的组合（中等强度干预），以及邮寄、互动会议、外展访问、提醒加上识别当地意见领袖和建立当地共识程序的组合（高强度干预）。主要目标是确定三种干预策略中哪一种在降低每1000例疾病发作的住院天数率方面最有效。次要目标是确定三种传播策略中哪一种在增加已知有益疗法的使用方面最有效。将进行经济分析以确定三种干预策略中哪一种将最有效地降低包括所有医疗保健成本、家庭承担的成本以及指南传播策略产生的成本在内的社会总成本。
