Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.
Implement Sci. 2012 Jun 30;7:58. doi: 10.1186/1748-5908-7-58.
Total hip and knee arthroplasties are two of the most commonly performed procedures in orthopedic surgery. Different blood-saving measures (BSMs) are used to reduce the often-needed allogenic blood transfusions in these procedures. A recent large randomized controlled trial showed it is not cost effective to use the BSMs of erythropoietin and perioperative autologous blood salvage in elective primary hip and knee arthroplasties. Despite dissemination of these study results, medical professionals keep using these BSMs. To actually change practice, an implementation strategy is needed that is based on a good understanding of target groups and settings and the psychological constructs that predict behavior of medical professionals. However, detailed insight into these issuses is lacking. Therefore, this study aims to explore which groups of professionals should be targeted at which settings, as well as relevant barriers and facilitators that should be taken into account in the strategy to implement evidence-based, cost-effective blood transfusion management and to de-implement BSMs.
The study consists of three phases. First, a questionnaire survey among all Dutch orthopedic hospital departments and independent treatment centers (n = 99) will be conducted to analyze current blood management practice. Second, semistructured interviews will be held among 10 orthopedic surgeons and 10 anesthesiologists to identify barriers and facilitators that are relevant for the uptake of cost-effective blood transfusion management. Interview questions will be based on the Theoretical Domains Interview framework. The interviews will be followed by a questionnaire survey among 800 medical professionals in orthopedics and anesthesiology (400 professionals per discipline) in which the identified barriers and facilitators will be ranked by frequency and importance. Finally, an implementation strategy will be developed based on the results from the previous phases, using principles of intervention mapping and an expert panel.
The developed strategy for cost-effective blood transfusion management by de-implementing BSMs is likely to reduce costs for elective hip and knee arthroplasties. In addition, this study will lead to generalized knowledge regarding relevant factors for the de-implementation of non-cost-effective interventions and insight in the differences between implementation and de-implementation strategies.
全髋关节和全膝关节置换术是矫形外科中最常进行的两种手术。为了减少这些手术中经常需要的异体输血，采用了不同的血液保护措施（BSMs）。最近的一项大型随机对照试验表明，在择期初次髋关节和膝关节置换术中使用促红细胞生成素和围手术期自体血回收这两种 BSM 并不具有成本效益。尽管这些研究结果得到了传播，但医务人员仍在继续使用这些 BSM。为了真正改变实践，需要制定实施策略，该策略需要基于对目标人群和环境以及预测医务人员行为的心理结构的良好理解。然而，目前对这些问题的详细了解还很缺乏。因此，本研究旨在探讨在实施基于证据的、具有成本效益的输血管理和取消 BSM 的策略中，应针对哪些专业人员在哪些环境中，以及应考虑哪些相关的障碍和促进因素。
该研究包括三个阶段。首先，将对所有荷兰矫形外科医院科室和独立治疗中心（n=99）进行问卷调查，以分析当前的血液管理实践。其次，将对 10 名矫形外科医生和 10 名麻醉师进行半结构式访谈，以确定与采用具有成本效益的输血管理相关的障碍和促进因素。访谈问题将基于理论领域访谈框架。访谈结束后，将对 800 名矫形和麻醉科医务人员（每科 400 名医务人员）进行问卷调查，对确定的障碍和促进因素进行频率和重要性排序。最后，将根据前几个阶段的结果，使用干预映射和专家小组的原则制定实施策略。
通过取消 BSM 来实现具有成本效益的输血管理的策略，有望降低择期髋关节和膝关节置换术的成本。此外，本研究将导致对非成本效益干预措施取消的相关因素以及实施和取消策略之间差异的普遍认识。
