Promoting Equity via Change in Practice for Respiratory Failure (PRECIPICE)

通过改变呼吸衰竭实践来促进公平 (PRECIPICE)

• 批准号: 10365559
• 负责人: Mari Armstrong-Hough
• 金额: $ 72.43万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10365559
• 关键词: Activities of Daily Living; Address; Age; American; Behavior; Belief; COVID-19; Caring; Cessation of life; Characteristics; Clinical; Clinical Data; Cognitive; Cohort Studies; Communication; Communication Barriers; Community Hospitals; Critical Care; Critical Illness; Data; Ethnic Origin; Family; Financial Hardship; Funding; Health Services Research; Hispanic; Hispanic Populations; Hospitals; Household; Intensive Care Units; Intervention; Interview; Knowledge; Literature; Measures; Methods; Modeling; Motivation; Multicenter Trials; National Heart, Lung, and Blood Institute; Not Hispanic or Latino; Nurses; Observational Study; Organization administrative structures; Outcome; Outcome Study; Patients; Physical Function; Physical therapy; Physicians; Positioning Attribute; Process; Public Health; Quality of life; Reporting; Research; Research Design; Research Personnel; Resources; Respiratory Failure; Risk; Sedation procedure; Severity of illness; Site Visit; Specific qualifier value; Structure; Surveys; Survivors; Testing; Time; Work; arm; base; behavior change; bilingualism; care delivery; clinical practice; cohort; comorbidity; design; disparity elimination; experience; functional outcomes; health disparity; health equity; improved outcome; innovation; mortality; multidisciplinary; patient registry; prototype; research and development; respiratory health; secondary analysis; sex; social determinants; sociologist; standard of care; success; therapy design

PROJECT SUMMARY Background: Approximately 300,000 Hispanic individuals experience respiratory failure each year in the U.S. Hispanic patients are twice as likely to die from respiratory failure as non-Hispanic patients. There is an urgent need to identify and remediate mechanisms for this disparity. The investigative team’s preliminary work identified two potential mechanisms: Hispanic patients with respiratory failure are more likely to be deeply sedated and less likely to receive physical therapy than non-Hispanic patients, which are both associated with mortality and poor long-term functional outcomes. The overall objective of this proposal is to promote equitable outcomes for Hispanic patients with respiratory failure through changes in intensive care unit (ICU) practice. Specific Aims and Project Methods: Aim 1: Evaluate trajectories of long-term functional outcomes for Hispanic and non-Hispanic survivors of respiratory failure. An analysis of a unique registry of patients with respiratory failure will examine risk-adjusted trajectories of six-month mortality and functional outcomes among 96 Hispanic and 96 matched non-Hispanic control patients. Aim 2: Characterize care delivery for respiratory failure by ethnicity. Detailed site visits at ten diverse U.S. hospitals will be integrated with interviews and surveys of ICU clinicians to understand delivery of deep sedation and other care processes that preliminary work demonstrate to be differentially applied by ethnicity. Aim 3: Refine and pilot an intervention targeting inequitable care delivery. The team’s preliminary intervention to promote equity in care delivery for respiratory failure will be iteratively refined through patient, family, and clinician engagement and piloted at two U.S. ICUs. Unique Aspects of this Proposal: This proposal tackles an enduring problem in critical care—detecting, understanding, and eliminating disparities—by uniting a sociologist with expertise in disparities research and intervention design with a critical care physician with expertise in health services research. With an experienced team of co-investigators, preeminent National Advisory Board, and rigorous mixed-methods design, the PIs are uniquely equipped to address this pressing challenge. Anticipated Impact: NHLBI’s Report on Addressing Respiratory Health Equity emphasizes the elimination of disparities in respiratory health will remain aspirational without robust evidence and innovations in intervention design. The outcome of this study will be a characterization of care delivery contributing to inequitable outcomes among Hispanic patients with respiratory failure and an intervention aimed at mitigating disparities.

项目总结 背景：在美国，每年约有30万西班牙裔患者发生呼吸衰竭。 西班牙裔患者死于呼吸衰竭的可能性是非西班牙裔患者的两倍。有一件急事 需要确定和补救解决这一差距的机制。调查组的前期工作 确定了两种潜在的机制：西班牙裔呼吸衰竭患者更有可能深度呼吸衰竭 与非西班牙裔患者相比，服用镇静剂和接受物理治疗的可能性较小，这两者都与 死亡率和较差的长期功能结果。这项提案的总体目标是促进公平 通过改变重症监护病房(ICU)实践，西班牙裔呼吸衰竭患者的结局。 具体目标和项目方法：目标1：评估长期功能结果的轨迹 呼吸衰竭的西班牙裔和非西班牙裔幸存者。一份独特的糖尿病患者登记表的分析 呼吸衰竭将检查风险调整后的六个月死亡率和功能结果的轨迹 96名西班牙裔患者和96名匹配的非西班牙裔对照组患者。目标2：描述呼吸系统护理服务的特点 由于种族原因而失败。对美国十家不同医院的详细实地考察将与采访和 对ICU临床医生进行的调查，以了解深度镇静和其他护理过程的初步情况 工作表现出根据种族的不同而不同。目标3：完善和试点干预目标 提供不公平的护理服务。该团队为促进呼吸系统护理服务的公平而进行的初步干预 失败将通过患者、家庭和临床医生的参与反复改进，并在两个美国ICU进行试点。 这项建议的独特之处：这项建议解决了重症监护中的一个持久问题-检测， 理解和消除差异--通过联合具有差异研究和专业知识的社会学家 由具有卫生服务研究专业知识的重症监护医生进行干预设计。带着一个 经验丰富的合作调查团队，卓越的国家咨询委员会，以及严格的混合方法 在设计上，PI具有独特的配置来应对这一紧迫挑战。 预期影响：NHLBI关于解决呼吸健康公平的报告强调消除 在没有强有力的证据和干预创新的情况下，呼吸健康方面的差异仍将是令人向往的 设计。这项研究的结果将是对造成不公平的护理提供的特征 西班牙裔呼吸衰竭患者的预后和旨在缓解差异的干预措施。