Adapting and testing a deimplementation program in the Intensive Care Unit

项目摘要/摘要 K-奖的目标是让候选人走上独立研究的道路。虽然 申请人在传播和实施科学方面接受过一些培训，这提供了初步数据 就她目前的提案而言，申请人需要接受更高级别的实施方法培训，以 推动她走向事业独立。申请者的目标是通过以下方式优化危重患者的护理 实现对循证证据的系统吸收的执行和取消执行方法 创新。重症监护医学有几个领域需要执行原则来结束 存在的证据与实践的差距。例如，每年有数百万名危重病人需要 中心静脉置管后的影像证实。新出现的文献表明，超声波 是一种比既往胸部X光更快的替代方法，因此是使用导管的理想确认。如果可以的话 为了确定导管的位置，超声波减少了不必要的胸部X光检查的次数，累积 资源(技术人员、放射科医生、设备)和患者护理延误。然而，提供商并没有采用 这种做法。在候选人之前的两年K奖期间，她开发并启动了一个成功的证据- 基于紧急情况下称为DRAUP的超声替代胸部X光的实施计划 部门。我们假设这个解除执行计划是从一个理论驱动的模型发展而来的 在行为改变轮框架的指导下，解决了行为的基本结构，从而 在任何环境下都应该是成功的。在这份K01建议书中，申请人试图证明 通过提炼、测试和确定机制来概括DRAUP的理论驱动结构 在一个新的环境中产生影响。因此，申请人提出了与NHLBI一致的研究议程 战略愿景目标6，用于“优化临床和实施研究以改善健康”的研究 并减少疾病。“在目标1中，申请人将采用一种系统的方法来改进DRAUP组件 根据重症监护病房的独特情况进行了剂量调整。在目标2中，申请者试图检查有效性 结果，重要的是取消执行--方案的成本效益。在目标3中，申请人 寻求用混合的方法来评价新环境下精细化方案的影响机制。 这些目标支持申请者的培训计划，在该计划中，她将接受专家指导和培训 干预规划(培训目标1)；成本效益分析(培训目标2)；混合方法 机械探索(训练目标3)，来自Elvin Geng、Richard Griffey、Aimee James和Derek博士 布朗。指导团队的专业知识，以及华盛顿的学术和培训环境 大学，将确保申请人的成功。这项研究的结果将被用来支持科学前提 取消执行方案，可在随后的多中心更大规模试验中进行测试，并可转让 到其他重症监护医学证据与实践的差距。

PROJECT SUMMARY/ ABSTRACT The goal of the K-award is to position the candidate on the pathway to independent research study. Although the applicant has some training in dissemination and implementation science, which provided preliminary data for her current proposal, the applicant needs to acquire higher level implementation methodology training to propel her towards career independence. The applicant’s goal is to optimize care for critically ill patients through implementation and deimplementation approaches that achieve systematic absorption of evidence-based innovations. There are several areas of critical care medicine in need of implementation principles to close the evidence-to-practice gap that exist. For example, there are millions of critically ill patients annually who require imaging confirmation after central venous catheter insertion. Emerging literature demonstrates that ultrasound is a faster alternative to historical chest xray, thus serving as the ideal confirmation for catheter use. When able to confirm catheter position, ultrasound decreases the number of unnecessary chest radiographs, cumulative resources (technologist, radiologist, equipment), and patient care delays. However, providers are not adopting this practice. During the candidates previous 2-year K award, she developed and initiated a successful evidence- based deimplementation program for ultrasound in lieu of chest xray called DRAUP in the Emergency Department. We hypothesize that this deimplementation program, developed from a theory-driven model and guided by the Behavioral Change Wheel framework addresses the foundational constructs of behavior thus should be successful in any environment. In this K01 proposal, the applicant seeks to demonstrate the generalizability of the theory-driven constructs of DRAUP by refining, testing, and determining the mechanism of impact in a new environment. Thus, the applicant proposes a research agenda that aligns with the NHLBI’s strategic vision objection #6 for studies that “optimize clinical and implementation research to improve health and reduce disease.” In Aim 1, the applicant will employ a systematic approach to DRAUP component refinement dosed to the unique context of the Intensive Care Unit. In Aim 2, the applicant seeks to examine effectiveness outcomes and importantly for de-implementation – cost effectiveness of the program. In Aim 3, the applicant seeks to use mixed methods to evaluate the mechanism of impact of the refined program in the new environment. These aims support the applicant’s training plan in which she will receive expert mentorship and training in Intervention Mapping (Training Goal 1); cost effectiveness analysis (Training Goal 2); and mix methods for mechanistic exploration (Training Goal 3) from Drs. Elvin Geng, Richard Griffey, Aimee James, and Derek Brown. Expertise of the mentorship team, along with the academic and training environment of Washington University, will ensure the applicant’s success. Results of this study will be used to support the scientific premise of the deimplementation program, which can be tested in a subsequent multicenter larger trial and transferrable to other critical care medicine evidence-to-practice gaps.