Eliminating Monitor Overuse (EMO) type III effectiveness-deimplementation cluster-randomized trial: Statistical...

Area of Science:

• Health services research
• Implementation science
• Pediatric medicine

Background:

• Overuse of health interventions can lead to harm and inefficiency.
• Continuous pulse oximetry (SpO2) monitoring is often overused in children not requiring supplemental oxygen, despite guidelines recommending against it.
• The Eliminating Monitor Overuse (EMO) SpO2 trial targets this guideline-discordant practice for deimplementation.

Purpose of the Study:

• To compare the effectiveness of two deimplementation strategies: unlearning alone versus unlearning plus substitution.
• To assess the sustainment of deimplementation of SpO2 monitoring in children with bronchiolitis on room air.

Main Methods:

• A hybrid type 3 effectiveness-deimplementation trial with a longitudinal cluster-randomized design.
• Generalized hierarchical mixed-effects models for longitudinal clustering outcomes to analyze deimplementation sustainment.
• Linear mixed-effects regressions for secondary outcomes (length of hospital stay, oxygen supplementation duration).

Main Results:

• This section details the statistical analysis plan, not the results.
• The primary outcome is deimplementation sustainment, analyzed using a difference-in-differences approach.
• Mediation analysis will explore hospital-level factors influencing deimplementation.

Conclusions:

• The EMO Trial is expected to advance deimplementation science by providing insights into sustained practice change.
• A pre-specified statistical analysis plan will ensure rigorous evaluation and mitigate reporting bias.
• This study supports data-driven approaches to optimize healthcare interventions.