Determinants of Implementation Success Coordinating Ventilator, Early Ambulation and Rehabilitation Efforts in the ICU (DISCOVER-ICU) study

ICU 中协调呼吸机、早期下床活动和康复工作的实施成功的决定因素 (DISCOVER-ICU) 研究

• 批准号: 10221262
• 负责人: Michele Christina Balas
• 金额: $ 15.6万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-27 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10221262
• 关键词: Admission activity; Adopted; Adoption; Adult; Agitation; Anxiety; Attitude; Beds; Biometry; Body mass index; Caring; Characteristics; Clinical; Clinical Medicine; Clinical Practice Guideline; Clinical Research; Cognitive; Collaborations; Communities; Critical Care; Critical Illness; Data; Data Collection; Delirium; Development; Diagnosis; Disease; Early Ambulation; Elderly; Excision; Exhibits; Face; Family; Future; Guidelines; Health; Heart Diseases; Hematological Disease; Hospitals; Hybrids; Impaired health; Impairment; Institutionalization; Intensive Care Units; Intervention; Knowledge; Lead; Light; Lung diseases; Mechanical ventilation; Medicine; Mental Depression; Methods; Modeling; National Heart, Lung, and Blood Institute; Neurocognitive Deficit; Outcome; Outpatients; Pain; Pain management; Patients; Pattern; Perception; Performance; Post-Traumatic Stress Disorders; Practice Management; Process; Protocols documentation; Provider; Psyche structure; Public Health; Randomized; Recommendation; Rehabilitation therapy; Reporting; Research; Resources; Risk; Sedation procedure; Self Efficacy; Severity of illness; Societies; Structure; Surveys; Testing; Variant; Ventilator; Vulnerable Populations; Work; adult obesity; clinical practice; concept mapping; data de-identification; demographics; design; effectiveness implementation trial; evidence base; experience; flexibility; functional decline; implementation research; implementation science; implementation strategy; improved; improved outcome; innovation; interest; member; professional atmosphere; residence; skills; success; survivorship; symptom management

There is a fundamental gap between the discovery of proven-effective intensive care unit (ICU) sedation, mechanical ventilation, mobility, and symptom management strategies and approaches that can equip ICU providers with the skills necessary to reliably adopt these interventions in everyday practice. Until this gap is filled, the millions of patients with heart, lung, and blood disorders admitted to ICUs annually will remain at risk for avoidable physical, mental, and cognitive health impairments that may persist for months to years after hospital discharge. In the proposed study, we will continue our partnership with the Society of Critical Care Medicine's (SCCM's) ICU Liberation Collaborative; a national quality improvement network comprised of 68 academic, community, and federal ICUs. Guided by the Consolidated Framework for Implementation Research, the overall objective of the Determinants of Implementation Success Coordinating Ventilator, Early Ambulation and Rehabilitation Efforts in the ICU (DISCOVER-ICU) study is to develop multilevel implementation strategies to enhance sustainable adoption of the ABCDEF bundle in routine ICU practice. The ABCDEF bundle is an evidence-based, multicomponent ICU management strategy that incorporates many of the SCCM's Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. Using a multiphase, sequential, mixed-methods design, this study has three specific aims: 1) estimate the effects of patient-level characteristics on ABCDEF bundle adoption; 2) examine unit-level variation in ABCDEF bundle adoption and associated provider- and organization-level characteristics; and 3) determine which implementation strategies result in the greatest adoption of the ABCDEF bundle. We will use existing deidentified data obtained from >15,000 patients, >5,000 interprofessional ICU team members, and 68 hospitals participating in the ICU Liberation Collaborative to achieve specific aims 1 and 2. For specific aim 3, we will extend data collection using interprofessional ICU team surveys, a modified Delphi process, and concept mapping to achieve greater understanding of implementation strategies that prove most effective for ABCDEF bundle adoption. Our focus on high- and low-ABCDEF bundle-performing units will allow us to select and tailor potential ABCDEF bundle implementation strategies to meet specific local contextual needs. This approach in innovative because it: capitalizes on existing data from a large, nationally representative network of ICUs; includes units with already known and highly variable ABCDEF bundle performance rates and implementation strategies; and allows for the examination of actual versus perceived ABCDEF Bundle performance. Results of this work will directly lead to the development of implementation strategies that are adaptable, responsive to community needs, and account for the cultural and organizational factors necessary to increase ABCDEF bundle adoption. These implementation strategies will then be tested in a future cluster randomized hybrid II implementation- effectiveness trial.

发现有效的重症监护病房（ICU）镇静剂之间存在根本差距， 机械通气，机动性和症状管理策略和方法可以为ICU配备 提供者具有可靠地在日常实践中采用这些干预措施所需的技能。直到这个差距为止 填满的是，每年接受ICU的数百万患有心脏，肺和血液疾病的患者将处于危险之中 对于可避免的身体，精神和认知健康障碍，可能会持续数月至几年 医院出院。在拟议的研究中，我们将继续与重症监护协会合作 医学（SCCM）ICU解放合作；国家质量改进网络由68个组成 学术，社区和联邦ICU。在实施研究的合并框架的指导下， 实施成功协调呼吸机的决定因素的总体目标，早期的移动 ICU（Discover-ICU）研究中的康复工作是制定多级实施策略 为了增强常规ICU实践中ABCDEF捆绑包的可持续采用。 ABCDEF捆绑包是 基于证据的多组分ICU管理策略，结合了SCCM的许多临床 ICU成年患者的疼痛，躁动和del妄的管理指南。使用 多相，顺序，混合方法设计，本研究具有三个特定的目的：1）估计 ABCDEF捆绑包的患者级特征； 2）检查ABCDEF捆绑包中的单位级变化 领养以及相关的提供商和组织级特征； 3）确定哪个实施 策略导致ABCDEF捆绑包的最大采用。我们将使用现有的去识别数据 从> 15,000名患者，> 5,000名专业ICU团队成员和68家医院参加ICU 解放协作以实现特定目标1和2。对于特定目标3，我们将使用数据收集数据。 专业专业的ICU团队调查，经过修改的Delphi过程和概念映射以实现更大的 了解对ABCDEF捆绑限制最有效的实施策略。我们的重点 在高和低ABCDEF捆绑包上的单元将使我们能够选择和量身定制潜在的ABCDEF捆绑包 实施策略以满足特定的当地上下文需求。这种创新的方法是因为它： 利用来自ICU的大型代表性网络的现有数据；包括已经 已知和高度可变的ABCDEF捆绑绩效率和实施策略；并允许 检查实际与感知的ABCDEF捆绑表性能。这项工作的结果将直接导致 适应能力的实施策略的制定，响应社区需求并说明 对于增加采用ABCDEF捆绑的必要文化和组织因素。这些 然后，将在未来的群集随机混合II实施中测试实施策略 - 有效试验。