Adapting and testing a deimplementation program in the Intensive Care Unit

在重症监护病房调整和测试取消计划

• 批准号: 10350297
• 负责人: ENYO ABLORDEPPEY
• 金额: $ 15.75万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10350297
• 关键词: Accident and Emergency department; Address; Adoption; Area; Behavior; Behavioral; Behavioral Mechanisms; Caring; Case Study; Catheters; Chest; Clinical; Clinical Research; Clinical effectiveness; Cost Effectiveness Analysis; Critical Care; Critical Illness; Data; Deimplementation; Disease; Dose; Electronic Health Record; Elements; Ensure; Environment; Equipment; Evidence based practice; Focus Groups; Foundations; Frequencies; Future; Gatekeeping; Goals; Health; Healthcare; Healthcare Systems; Hospitals; Image; Incentives; Individual; Intensive Care Units; Intervention; Interview; K-Series Research Career Programs; Literature; Measures; Medical; Medicine; Mentored Research Scientist Development Award; Mentorship; Methodology; Methods; Modeling; Motivation; National Heart, Lung, and Blood Institute; Operative Surgical Procedures; Pathway interactions; Patient Care; Patients; Perception; Pilot Projects; Policies; Positioning Attribute; Process; Program Effectiveness; Protocols documentation; Provider; Public Health; Qualitative Research; Research; Resources; Sample Size; Science; Services; Strategic vision; Structure; Surveys; Testing; Thoracic Radiography; Training; United States; Universities; Venous; Washington; Work; absorption; acute care; behavior change; behavioral construct; career; cost effectiveness; design; dissemination science; effectiveness measure; effectiveness outcome; evidence base; experience; hospital organization; implementation evaluation; implementation outcomes; implementation research; implementation science; improved; innovation; insight; intervention mapping; intervention program; personalized care; point of care; programs; radiologist; research study; success; successful intervention; theories; trial design; ultrasound

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.

项目总结/摘要 K奖的目标是将候选人定位在独立研究学习的道路上。虽然 申请人在传播和实施科学方面受过一些培训，提供了初步数据 对于她目前的建议，申请人需要获得更高级别的实施方法培训， 促使她走向职业独立。申请人的目标是通过以下方式优化重症患者的护理 执行和不执行的办法，实现系统地吸收 创新。有几个重症监护医学领域需要实施原则，以关闭 存在的证据与实践差距。例如，每年有数百万的重症患者需要 中心静脉导管插入后的影像学确认。新兴文献表明，超声 是历史胸部X线的更快替代品，因此可作为导管使用的理想确认。当能够 为了确认导管位置，超声减少了不必要的胸部X光片的数量，累积 资源（技师、放射科医师、设备）和患者护理延迟。然而，供应商并没有采用 这种做法。在候选人之前的2年K奖，她开发并发起了一个成功的证据- 在紧急情况下，基于超声代替胸部X光检查的取消计划，称为DRAUP 部门我们假设，这种去实现程序，从理论驱动的模型， 在行为改变轮框架的指导下， 在任何环境下都能成功。在本K 01提案中，申请人试图证明 通过提炼、测试和确定机制，使理论驱动的DRAUP结构具有可推广性 在新环境中的影响。因此，申请人提出了一个研究议程，符合NHLBI的 战略愿景反对意见6：“优化临床和实施研究以改善健康” 减少疾病”。在目标1中，申请人将采用系统化方法对DRAUP组件进行细化 在重症监护室的特殊环境下使用在目标2中，申请人寻求审查有效性 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 的目的是使用混合的方法来评估在新的环境中的细化程序的影响机制。 这些目标支持申请人的培训计划，在该计划中，她将获得专家指导和培训， 干预映射（培训目标1）;成本效益分析（培训目标2）;以及 来自Elvin Geng博士、Richard Griffey博士、Aimee James博士和Derek博士的机械探索（培训目标3） 布朗导师团队的专业知识，沿着华盛顿的学术和培训环境 大学，将确保申请人的成功。本研究的结果将用于支持科学前提 该计划可以在随后的多中心大型试验中进行测试，并可转移 其他重症监护医学的循证实践差距。