Implementing nudges to promote utilization of low tidal volume ventilation (INPUT): a stepped-wedge, hybrid type III trial of strategies to improve evidence-based mechanical ventilation management.
Implementing nudges to promote utilization of low tidal volume ventilation (INPUT): a stepped-wedge, hybrid type III trial of strategies to improve evidence-based mechanical ventilation management.
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实施引导措施以促进低潮气量通气的应用（INPUT）：一项改善循证机械通气管理策略的阶梯式整群、混合型III期试验
DOI：
10.1186/s13012-021-01147-7
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发表时间：
2021-08-10
期刊：
影响因子：
--
通讯作者：
Beidas RS
中科院分区：
文献类型：
--
作者：
Kerlin MP;Small D;Fuchs BD;Mikkelsen ME;Wang W;Tran T;Scott S;Belk A;Silvestri JA;Klaiman T;Halpern SD;Beidas RS
行为经济学的见解已经产生了克服实施障碍的策略。例如，默认策略和责任说明策略提高了临床环境中对最佳实践的遵循度。将此类策略嵌入电子健康记录（EHR）有望为促进实施提供简单且可扩展的方法。对于接受机械通气的患者，一种已被证明有效但未得到充分利用的治疗方法是规定低潮气量，这可以保护肺部免受损伤。我们将评估基于行为经济学理论的基于EHR的实施策略，以改善机械通气的循证管理。
“实施助推措施以促进低潮气量通气的应用（INPUT）”研究是一项务实的、阶梯式楔形、混合型III类有效性实施试验，涉及三种提高对低潮气量通气遵循度的策略。这些策略针对输入电子医嘱的临床医生和管理机械通气机的呼吸治疗师这两个关键的利益相关群体。INPUT有五个研究组：常规护理、机械通气医嘱中的默认策略、机械通气医嘱中的责任说明策略，以及每种医嘱策略与流程单记录中的责任说明策略相结合。我们将在一个大型医疗系统的五家医院中创建12个重症监护病房（ICU）的六对匹配组，以平衡患者数量和对低潮气量通气的基线遵循度。我们将在每对匹配组内随机将ICU分配到其中一个医嘱组，并将每对分配到六个楔形组中的一个，这将决定医嘱组策略的采用日期。所有ICU将在6个月后采用流程单记录策略。主要结局将是对低潮气量通气的依从性。次要有效性结局将包括住院死亡率、机械通气持续时间、ICU和住院时长以及潜在不良事件的发生情况。
这项阶梯式楔形、混合型III类试验将提供关于基于EHR的行为经济学策略在提高ICU中接受机械通气患者对循证实践的遵循度方面所起作用的证据，从而推动实施科学领域的发展，并在广泛的患者群体中测试低潮气量通气的有效性。
ClinicalTrials.gov，NCT04663802。2020年12月11日注册。
Behavioral economic insights have yielded strategies to overcome implementation barriers. For example, default strategies and accountable justification strategies have improved adherence to best practices in clinical settings. Embedding such strategies in the electronic health record (EHR) holds promise for simple and scalable approaches to facilitating implementation. A proven-effective but under-utilized treatment for patients who undergo mechanical ventilation involves prescribing low tidal volumes, which protects the lungs from injury. We will evaluate EHR-based implementation strategies grounded in behavioral economic theory to improve evidence-based management of mechanical ventilation. The Implementing Nudges to Promote Utilization of low Tidal volume ventilation (INPUT) study is a pragmatic, stepped-wedge, hybrid type III effectiveness implementation trial of three strategies to improve adherence to low tidal volume ventilation. The strategies target clinicians who enter electronic orders and respiratory therapists who manage the mechanical ventilator, two key stakeholder groups. INPUT has five study arms: usual care, a default strategy within the mechanical ventilation order, an accountable justification strategy within the mechanical ventilation order, and each of the order strategies combined with an accountable justification strategy within flowsheet documentation. We will create six matched pairs of twelve intensive care units (ICUs) in five hospitals in one large health system to balance patient volume and baseline adherence to low tidal volume ventilation. We will randomly assign ICUs within each matched pair to one of the order panels, and each pair to one of six wedges, which will determine date of adoption of the order panel strategy. All ICUs will adopt the flowsheet documentation strategy 6 months afterwards. The primary outcome will be fidelity to low tidal volume ventilation. The secondary effectiveness outcomes will include in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay, and occurrence of potential adverse events. This stepped-wedge, hybrid type III trial will provide evidence regarding the role of EHR-based behavioral economic strategies to improve adherence to evidence-based practices among patients who undergo mechanical ventilation in ICUs, thereby advancing the field of implementation science, as well as testing the effectiveness of low tidal volume ventilation among broad patient populations. ClinicalTrials.gov, NCT04663802. Registered 11 December 2020.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
25.8
作者：
Beidas RS;Buttenheim AM;Mandell DS
通讯作者：
Mandell DS
影响因子：
3
作者：
Escobar, Gabriel J.;Gardner, Marla N.;Kipnis, Patricia
通讯作者：
Kipnis, Patricia
DOI：
10.1007/s10488-008-0197-4
发表时间：
2009-01
影响因子：
2.6
作者：
Proctor, Enola K.;Landsverk, John;Aarons, Gregory;Chambers, David;Glisson, Charles;Mittman, Brian
通讯作者：
Mittman, Brian
影响因子：
8.8
作者：
Rubenfeld, GD;Cooper, C;Hudson, LD
通讯作者：
Hudson, LD