Improving the efficiency of randomized trials of behavioral interventions for acute and chronic respiratory failure

这一以患者为中心的研究生涯中期奖的目标是提高博士的能力。 Scott Halpern在开发和测试方面指导学生、住院医生、博士后研究员和初级教员 预防和改善急性和慢性呼吸系统疾病后果的行为经济干预 失败了。患有多种形式的急性和慢性呼吸衰竭的患者，如急性呼吸窘迫 综合征(ARDS)和慢性阻塞性肺疾病(COPD)分别是死亡的高风险 并在生活质量和功能方面遭受相当大的短期和长期损害。行为 干预措施，包括那些以行为经济学原则为依据的干预措施，对预防 这些条件和不断改善的结果。然而，由随机临床试验(RCT)产生的知识 由于阻碍了患者应得的、以患者为中心的结果确定，这种干预措施受到限制， 以及传统分析确定哪些干预措施对哪些患者最有效的能力。 通过利用概念模型、研究基础设施和在Halpern博士正在进行的 或者最近完成的RCT，包括40,000名患者，Halpern博士和他的学员将开发和测试方法 要克服这三个障碍，以便更多地了解如何预防和治疗急性呼吸道感染 和慢性呼吸衰竭。首先，他们将进行随机试验，以提高招生人数和 真实随机对照试验中的保留率。第二，他们将学习和应用最先进的自然语言处理和 机器学习技术增强从电子健康中提取以患者为中心的结果的能力 记录，从而在大型、务实的随机对照试验中确定更有效的结果确定方法。第三, 他们将学习并应用现代方法进行因果推断和异质治疗的检测 效果，以更好地了解行为干预总体上有多有效，如果 更多的患者坚持使用它们，以及哪些干预措施对哪些患者最有效。 这些科学目标将在旨在改进的结构化培训方案的背景下完成 哈尔彭博士在指导以病人为导向的初级研究人员方面的技能。Halpern博士已经成功地 指导了20多名以患者为导向的研究人员。然而，通过使他能够减少他的临床 和行政承诺，这一奖励将增加他承诺指导的时间，并将改善 他的指导技能，通过支持影响力和领导力的说教培训以及“指导者” 与更资深的导师会面。该奖项还将使他能够发展出一种“初级教职访问” 肺和重症监护医学教授计划，从而增加了HIS和 其他既定调查人员的指导者与该领域的其他领导者建立网络，接收外部反馈 和指导，并在与不太熟悉的观众交谈时获得自信。

The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Scott Halpern to mentor students, residents, post-doctoral fellows, and junior faculty in developing and testing behavioral economic interventions to prevent and improve outcomes following, acute and chronic respiratory failure. Patients with many forms of acute and chronic respiratory failure, such as acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD), respectively, are at high risk of death and suffer considerable short- and long-term impairments in quality of life and functioning. Behavioral interventions, including those informed by behavioral economic principles, hold great promise for preventing these conditions and improving outcomes. Yet the knowledge produced by randomized clinical trials (RCTs) of such interventions is limited due to impediments to patient accrual, patient-centered outcomes ascertainment, and the abilities of traditional analyses to determine which interventions work best for which patients. By leveraging the conceptual models, research infrastructures, and data collected in 5 of Dr. Halpern's ongoing or recently completed RCTs including 40,000 patients, Dr. Halpern and his mentees will develop and test ways to surmount each of these three barriers to producing greater knowledge on how to prevent and treat acute and chronic respiratory failure. First, they will conduct randomized trials of “nudges” to improve enrollment and retention in real RCTs. Second, they will learn and apply state-of-the-art natural language processing and machine learning techniques to enhance the ability to extract patient-centered outcomes from electronic health records, thereby identifying more efficient methods for outcome ascertainment in large, pragmatic RCTs. Third, they will learn and apply modern methods in causal inference and the detection of heterogeneous treatment effects to better understand how effective behavioral interventions are overall, how efficacious they would be if more patients adhered to them, and which interventions work best for which patients. These scientific aims will be completed within the context of a structured training program designed to improve Dr. Halpern's skills in mentoring junior patient-oriented researchers. Dr. Halpern has already successfully mentored more than two dozen patient-oriented researchers. However, by enabling him to reduce his clinical and administrative commitments, this award will increase the time he commits to mentoring, and will improve his mentoring skills by supporting didactic training in influence and leadership and “mentor-the-mentor” meetings with more senior mentors. The award will also enable him to develop a “Junior Faculty Visiting Professor Program in Pulmonary and Critical Care Medicine,” thereby enhancing opportunities for his and other established investigators' mentees to network with other leaders in the field, receive external feedback and mentorship, and gain the confidence that comes with speaking to less familiar audiences.