Change Theory Contributes to Choosing Wisely for Immune Thrombocytopenia

Hospital Pediatrics
Matthew SchefftGita Massey

Abstract

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. 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. One hundred children with aITP were seen from January 2013 to September 2018. UT decreased from 70% to a sustained rate of <30% (P = .008), including a mean ...Continue Reading

References

Apr 21, 2007·Seizure : the Journal of the British Epilepsy Association·John O ElliottMercedes P Jacobson
Feb 18, 2011·Blood·Cindy NeunertUNKNOWN American Society of Hematology
Jun 12, 2013·JAMA Pediatrics·Alan R Schroeder, Rita F Redberg
Dec 17, 2014·Journal of Thrombosis and Haemostasis : JTH·C NeunertD M Arnold
Jun 7, 2018·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Paul C NathanK Robin Yabroff

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Citations

Mar 18, 2020·Hospital Pediatrics·Matthew SchefftJose Munoz
Dec 30, 2021·Health Education & Behavior : the Official Publication of the Society for Public Health Education·Lyen C HuangKimberly A Kaphingst

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