Evidence-Based Practice Education for Dizziness

(DIZZTINCT2 Trial)

Overseen By Huong Nguyen, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Prisoners, Death, Level 1 trauma, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 14

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial focuses on improving dizziness treatment in emergency rooms, particularly for conditions like vertigo, vestibular neuritis (inflammation of the inner ear nerve), and strokes. Researchers aim to evaluate how educational materials and strategies assist doctors and patients in managing these conditions more effectively. Participants may receive either special educational resources or standard care, depending on their group. Individuals who have been discharged from an ER visit for dizziness in the past 48 hours and speak English or Spanish may be suitable candidates. As an unphased trial, this study provides a unique opportunity to enhance emergency care for dizziness.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that this educational intervention is safe for dizziness management?

Previous studies have shown that educational programs for dizziness are safe for people. Research on Continuing Medical Education (CME) activities, like those in this trial, generally shows they are well-tolerated. No harmful effects have been reported from these programs.

Additionally, studies indicate that educational materials for patients, such as those used in exercises for balance and dizziness, are safe and effective. These materials have been safely used to help people understand and manage conditions like benign paroxysmal positional vertigo (BPPV).

Both the CME educational programs for healthcare providers and the educational materials for patients have a strong safety record. They aim to improve understanding and treatment without causing harm. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores a new approach to managing dizziness through targeted education for both healthcare providers and patients. Unlike traditional treatments for dizziness that often focus solely on medications or vestibular rehabilitation exercises, this trial emphasizes the power of education to improve patient outcomes. By equipping physicians with the DIZZTINCT educational intervention and providing patients with tailored educational materials, the trial aims to enhance understanding, diagnosis, and management of dizziness. This could potentially lead to more informed decision-making and better tailored treatments, making it a promising area of research for improving care in dizziness management.

What evidence suggests that this trial's educational interventions could be effective for dizziness management?

This trial will evaluate the impact of educational interventions on dizziness management. Research has shown that teaching both doctors and patients can help manage dizziness, such as the common inner ear issue BPPV. In this trial, some groups will have physicians receiving a Continuing Medical Education (CME) intervention, while others will not. One study found that when doctors learned more about BPPV, they provided better care, leading to improved patient outcomes. Additionally, some groups will involve patients receiving educational materials developed for dizziness management. Another study showed that when patients used educational materials to learn how to manage BPPV themselves, they felt more confident and experienced less dizziness over time. Furthermore, studies indicate that resources like booklets can help patients stick to exercises, improve their balance, and reduce dizziness. These findings suggest that educating both doctors and patients effectively manages dizziness. ^{2 3 5 6 7}

Who Is on the Research Team?

Kevin Kerber, MD

Principal Investigator

Ohio State University

Huong Nguyen, PhD

Principal Investigator

Kaiser Permanente

Will Meurer, MD

Principal Investigator

University of Michigan

Are You a Good Fit for This Trial?

This trial is for adults over 18 who've been discharged from certain emergency departments in the last 48 hours with a primary diagnosis of dizziness or related vestibular disorders. Participants must be Kaiser Permanente members, speak English or Spanish, and able to consent. Those with severe trauma, previous study enrollment, or inability to consent are excluded.

Inclusion Criteria

Discharged home from ED or Observation from one of 14 Kaiser Permanente Southern California (KPSC) Emergency Departments within the last 48 hours (Enrolled population)

Continuous health plan membership in the last 31 days prior to the encounter

I was diagnosed with dizziness or balance issues as my main health problem.

Exclusion Criteria

I am able to understand and agree to participate in research.

Prisoners

I have been diagnosed with a major injury.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Pre-Intervention

Initial no intervention period to establish baseline data

Varies

Intervention

Randomized staggered intervention at EDs with CME sessions and patient education materials

11 waves

Multiple visits across 14 EDs

Follow-up

Participants are monitored for documentation of DHT/CRM and dizziness disability using DHI

4 weeks

Weekly computerized surveys

What Are the Treatments Tested in This Trial?

Interventions

• CME Educational Intervention
• Study Developed Educational Materials for Patients

Trial Overview

The study tests how well evidence-based practices for managing dizziness (like BPPV) are implemented in emergency departments. It uses an enhanced strategy developed from prior research and assesses its effectiveness through a stepped-wedge design and randomized patient-level dissemination.

How Is the Trial Designed?

Group I: Group 6: Post-CME with Chart Review Only Experimental Treatment 1 Intervention

Physicians in hospitals that have received the DIZZTINCT educational intervention. Eligible patient will have their medical records abstracted to assess the main study outcome

Group II: Group 5: Post-CME with Standard Patient Care Experimental Treatment 1 Intervention

Physicians in hospitals that have received the DIZZTINCT educational intervention. Patients have not receive the DIZZTINCT educational intervention

Group III: Group 4: Post-CME with Patient Education Experimental Treatment 2 Interventions

Physicians in hospitals that have received the DIZZTINCT educational intervention. Patients have receive the DIZZTINCT educational intervention

Group IV: Group 1: Pre-CME with Patient Education Experimental Treatment 1 Intervention

Physicians in hospitals that have not received the DIZZTINCT educational intervention. Patients have received the DIZZTINCT educational intervention

Group V: Group 2: Pre-CME with Standard Patient Care Active Control 1 Intervention

Physicians in hospitals that have not received the DIZZTINCT educational intervention. Patients have not received the DIZZTINCT educational intervention

Group VI: Group 3: Pre-CME with Chart Review Only Active Control 1 Intervention

Physicians in hospitals that have not received the DIZZTINCT educational intervention. Eligible patient will have their medical records abstracted to assess the main study outcome

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Kaiser Permanente

Collaborator

Trials

563

Recruited

27,400,000+

University of Michigan

Collaborator

Trials

1,891

Recruited

6,458,000+

Published Research Related to This Trial

A systematic review of 136 articles found that continuing medical education (CME) is generally effective in improving physicians' knowledge, attitudes, skills, and clinical practice behaviors, despite the overall low quality of the evidence.

Live and multimedia formats of CME were more effective than print materials, and multiple exposures to educational content yielded better outcomes than single sessions, highlighting the need for more research to optimize CME strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of continuing medical education. Marinopoulos, SS., Dorman, T., Ratanawongsa, N., et al.[2022]

An outcome-based educational intervention for general physicians led to a significant reduction in the total number of prescribed drugs and injections, as well as improved compliance with prescription guidelines, after 3 months.

While the intervention showed positive effects on certain prescribing behaviors, it did not significantly improve the prescribing of antibiotics and anti-inflammatory agents, indicating that further improvements are needed in these areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can rational prescribing be improved by an outcome-based educational approach? A randomized trial completed in Iran. Esmaily, HM., Silver, I., Shiva, S., et al.[2019]

Qualitative analysis is underutilized in assessing outcomes in Continuing Medical Education (CME) and Continuing Professional Development (CPD), despite its potential to provide deep insights into learning and behavior changes.

The paper highlights the importance of understanding the contextual factors, such as norms and motivations, that influence education outcomes for both clinicians and patients, suggesting that qualitative methodologies could enhance the evaluation of educational programs aimed at improving patient health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Qualitative Outcomes in CME/CPD: Exploring Non-Linear Contexts and Lived Experiences in Patient-Directed Interventions. Howson, A., Turell, W.[2021]

The Performance Improvement Continuing Medical Education (PI CME) initiative successfully implemented four tobacco cessation programs, demonstrating improvements in practitioner performance and smoking quit rates, showcasing the efficacy of this educational approach.

The case examples emphasize the importance of collaboration and highlight how different operational and educational designs can influence compliance with performance measures, providing valuable insights for future PI CME activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sharing collaborative designs of tobacco cessation performance improvement CME projects. Mullikin, EA., Ales, MW., Cho, J., et al.[2011]

The implementation of an evidence-based practice (EBP) tutorial and access to UpToDate (UTD) did not lead to improved clinical knowledge scores (CKS) among participants, indicating that simply providing educational resources may not be sufficient to enhance knowledge in surgical practice.

Barriers such as administrative disconnect, usability issues, and language proficiency significantly impacted the effectiveness of point-of-care medical information systems, suggesting that addressing these barriers is crucial for improving EBP among healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does Access to Point-of-Care Medical Information Improve Trauma and General Surgeons' Clinical Knowledge in a Middle-Income Country? A Mixed-Methods Study with Random Assignment. Noble, H., Ordoñez, WJN., Zavala Wong, G., et al.[2023]

Interactive educational methods, such as combined didactic presentations and workshops, are more effective than traditional lectures alone in improving medical education outcomes.

Educational interventions are most successful when they are targeted at simple behaviors and implemented over an extended period, highlighting the importance of evidence-based approaches in continuing medical education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effective medical education: insights from the Cochrane Library. Satterlee, WG., Eggers, RG., Grimes, DA.[2022]

Effective professional medical education is essential for clinicians to stay updated with rapidly evolving evidence, which ultimately improves patient care quality.

A variety of educational approaches, including traditional, constructivist, and blended learning methods, can enhance the mobilization of evidence in clinical practice, but selecting the right combination is crucial for success.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Professional medical education approaches: mobilizing evidence for clinicians. Lyu, X., Li, S.[2023]

Over 70% of studies reviewed showed that continuing medical education (CME) and related educational methods effectively improved physician performance, while nearly 48% led to better health care outcomes.

Community-based strategies like academic detailing and practice-based methods such as reminders were the most effective, whereas traditional CME conferences without supportive strategies had minimal impact.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does CME work? An analysis of the effect of educational activities on physician performance or health care outcomes. Davis, D.[2019]

Current evaluations of continuing medical education (CME) typically focus on participation, satisfaction, knowledge, behavior, and patient outcomes, but there is a lack of studies connecting costs and effectiveness to improved quality of care.

In a competitive environment for educational resources, incorporating cost into CME evaluations can provide valuable insights into the effectiveness and value of these programs, helping to justify the resources spent.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Continuing medical education costs and benefits: lessons for competing in a changing health care economy. Mazmanian, PE.[2019]

Passive educational methods, like conferences and unsolicited materials, are generally ineffective in changing medical practice behaviors or improving patient outcomes.

More effective educational strategies are those that are practice- and community-based, involve assessing learning needs, and promote active participation in various activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Educational strategies to modify physician behaviours and health care outcomes]. Nendaz, M.[2019]

Continuous Medical Education (CME) has been shown to improve patient outcomes, especially when it includes a combination of evidence-based routines, new skills, and team training.

Healthy and well-trained staff are crucial for delivering better care, and addressing staff burnout is important for both patient safety and staff well-being, suggesting that CME should be integrated into quality and patient safety organizations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Continuous medical education and patient safety]. Escher, C., Felländer-Tsai, L.[2019]

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