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.

在发现有效的重症监护室（ICU）镇静， 机械通气、移动性和症状管理策略和方法， 提供者具备在日常实践中可靠地采用这些干预措施所需的技能。直到这个缺口 尽管如此，每年入住ICU的数百万患有心脏、肺和血液疾病的患者仍将面临风险 对于可避免的身体，精神和认知健康障碍，可能会持续数月至数年后， 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解放协作;由68个国家组成的国家质量改进网络 学术、社区和联邦ICU。在执行情况研究综合框架的指导下， 实施成功的决定因素协调呼吸机、早期Amplitude的总体目标 和ICU康复工作（DISCOVER-ICU）研究的目的是制定多层次的实施策略 加强ABCDEF捆绑包在常规ICU实践中的可持续采用。ABCDEF包是一个 以证据为基础的多成分ICU管理策略，包括许多SCCM的临床 ICU中成人患者疼痛、躁动和谵妄管理的实践指南。使用 本研究采用多阶段、序贯、混合方法设计，有三个具体目的：1）估计 ABCDEF束采用的患者水平特征; 2）检查ABCDEF束中的单位水平变化 采用和相关的提供者和组织级别的特征;以及3）确定 战略导致ABCDEF捆绑包的最大采用。我们将使用现有的去识别数据获得 来自> 15，000名患者，> 5，000名跨专业ICU团队成员和68家参与ICU的医院 解放协作，以实现具体目标1和2。对于具体目标3，我们将扩展数据收集， 跨专业ICU团队调查，修改后的德尔菲过程和概念图，以实现更大的 了解被证明对ABCDEF捆绑包采用最有效的实施策略。我们的重点 在高和低ABCDEF战斗性能的单位将使我们能够选择和定制潜在的ABCDEF捆绑 执行战略，以满足当地具体情况的需要。这种方法具有创新性，因为它： 利用来自一个具有全国代表性的大型ICU网络的现有数据;包括已经 已知的和高度可变的ABCDEF捆绑性能率和实施策略;并允许 检查实际与感知的ABCDEF捆绑包性能。这项工作的结果将直接导致 制定适应性强、能满足社区需求并考虑到 增加ABCDEF捆绑包采用所需的文化和组织因素。这些 然后，将在未来的集群随机混合II实施中测试实施策略- 有效性试验。