Change Theory Contributes to Choosing Wisely for Immune Thrombocytopenia

Abstract

A B S T R A C TOBJECTIVES: 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 5 .008), including a mean of 7% over the past 12 months. The admission rate decreased from 100% to 52% (P 5 .013), and the total percentage of patients treated decreased from 100% to 48% (P 5 .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.

Promoting Disposal of Left-Over Opioids After Surgery in Rural Communities: A Qualitative Description Study

“…We used six of the seven stages of PAPM (Figure 1). PAPM has been used to address vaccination hesitancy, cancer screening, disaster preparation, and unnecessary medical treatments (Glik et al, 2014; Jin et al, 2019; Schefft et al, 2019; Tatar et al, 2019). Consistent with qualitative best practices and the use of semistructured interviews, no counts or percentages were reported (Tracy, 2020).…”

“…We used six of the seven stages of PAPM (Figure 1). PAPM has been used to address vaccination hesitancy, cancer screening, disaster preparation, and unnecessary medical treatments (Glik et al, 2014;Jin et al, 2019;Schefft et al, 2019;Tatar et al, 2019).…”