Implementation Fidelity and Benefits of the Critical Care Pediatric Guideline Adherence and Outcomes Program in Traumatic Brain Injury

项目概要/摘要 创伤性脑损伤（TBI）是美国和全球儿童的公共卫生危机。 目前还没有经过证实的治疗TBI的疗法，并且基于证据的指南已经 在过去20年中制定了指导当前最佳做法的准则。然而， 缺乏战略。在之前的工作中，我们发现遵守TBI指南是 在美国5个领先的学术中心，与6%的更好的结果。然而，TBI 指南的依从性仍然很低，并且指南具有与以下方面相关的局限性： 建议适用于整个卫生保健系统和国家。在 作为回应，我们开发并试点测试了一个创新的多层次儿科指南 遵守和结果（PEGASUS）计划，以提高TBI指南遵守。 初步数据显示，TBI指南遵守的障碍是可以补救的， 基于指南的重症监护获益结果。该提案是一项合作， 美国和阿根廷TBI临床研究人员致力于了解TBI指南 坚持。本提案的总体目标是以理论领域为指导， 框架.我们建议进行一项实用的群集随机对照试验， PEGASUS计划（干预）和改善TBI指南依从性（主要结局） 在阿根廷六个研究中心的严重儿童TBI中。使用混合方法，我们建议 3具体目标：1）确定PEGASUS计划之间的关系 实施和TBI指南遵守（目标1a），以及评估系统、提供商 与TBI指南依从性相关的患者、实施和指南因素（目的 1b），2）创建易于识别护理增值过程的价值流图 与TBI指南依从性相关，以及3）使用计算机模拟来开发和 传播遵守TBI指南的真实的世界最佳实践蓝图。这是一 必要的进步和一个步骤，以实施基于指南的创伤性脑损伤儿童护理 患有TBI的人。

Project Summary/Abstract Traumatic brain injury (TBI) is a public health crisis for children in the US and worldwide. There are no proven therapies to treat TBI, and evidenced-based guidelines have been developed over the past 2 decades to guide best current practices. Yet, implementation strategies are lacking. In prior work, we found that adherence to the TBI guidelines was associated with 6% better outcomes in 5 leading U.S. academic centers. However, TBI guideline adherence remains low and the guidelines have limitations related to recommendation applicability across health care systems and across countries. In response, we developed and pilot tested an innovative multilevel Pediatric Guideline Adherence and Outcomes (PEGASUS) program to increase TBI guideline adherence. Preliminary data show that barriers to TBI guideline adherence are remediable and TBI guideline based intensive care benefits outcomes. This proposal is a collaboration between U.S. and Argentine TBI clinical investigators dedicated to understanding TBI guideline adherence. The overarching aim of this proposal is guided by the Theoretical Domain Framework. We propose to conduct a pragmatic cluster randomized controlled trial of the PEGASUS program (intervention) and to improve TBI guideline adherence (main outcome) in severe pediatric TBI across six Argentine study sites. Using mixed-methods, we propose 3 Specific Aims: 1) Determine the relationship between PEGASUS program implementation and TBI guideline adherence (Aim 1a), and assess system, provider, patient, implementation and guideline factors associated with TBI guideline adherence (Aim 1b), 2) Create a value stream map that readily identifies value added process of care associated with TBI guideline adherence, and 3) Use computer simulation to develop and disseminate a real world best practices blueprint for TBI guideline adherence. This is a necessary advance and a step towards implementing guideline-based TBI care for children who suffer from TBI.