Organizational Interventions for SSI Prevention in Pediatric Spinal Surgery

小儿脊柱手术中 SSI 预防的组织干预

• 批准号: 8662246
• 负责人: Lisa M. McLeod
• 金额: $ 14.93万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8662246
• 关键词: Organizational; Interventions; SSI; Prevention; Pediatric

DESCRIPTION (provided by applicant): Dr. McLeod, MD, MSCE is a junior investigator in pediatric hospital medicine with advanced training in clinical epidemiology and quantitative analyses. Her research is focused on the comparative effectiveness of interventions for preventing surgical site infections (SSI) following spinal fusion operations in children, with an emphasis on the association between elements of the organizational contexts of care and patient-centered outcomes. In the K99 portion of this proposal, Dr. McLeod describes a multi-disciplinary career development program that will build on her existing skills and will provide advanced training in qualitative and mixed method research, quasi-experimental study designs, and implementation science, all of which will be instrumental to her future success as an independent health services investigator focused on the improvement of patient- centered outcomes in children hospitalized with complex medical and surgical conditions. The K99 research plan outlined in Aim 1 will use quantitative and qualitative methods to explore hospital-specific organizational factors that distinguish high versus low performance in SSI prevention (as determined by adjusted rates of SSI). In addition to providing Dr. McLeod with mentorship and rigorous training in mixed method research, completion of this project will generate hypotheses about organizational barriers and facilitators to the effective implementation of SSI prevention practices. These findings will then serve as the foundation for the R00 proposal (Aim 2) to independently execute a multi-center trial comparing the effectiveness of existing implementation strategies at low performing hospitals to the effectiveness of a tailored (informed by Aim1 barriers/facilitators), multi-disciplinary approach to designing, implementing, and evaluating a patient-focused and patient-informed intervention to reduce SSIs and the preventable harms resulting from them. Applying the skills and training acquired during the K99 phase, this trial will use a novel mixed method approach that addresses limitations in prior research by (1) allowing for the exploration of contextual factors that are not readily measured using quantitative methods alone, and (2) involving at all stages family perspectives on barriers and facilitators to improving quality and outcomes of care for their children. To accomplish her transition, Dr. McLeod has assembled an outstanding team of mentors led by Ron Keren, MD, MPH and renowned orthopedic surgeon, John Dormans, MD, and will continue to benefit from the rich resources offered by the University of Pennsylvania and Children's Hospital of Philadelphia. Importantly, this research will serve as a proof-of-concept for the use of comprehensive patient-focused strategies for improving the implementation effectiveness of interventions to prevent complications following surgical procedures in children, and will inform future multi-center trials to operationalize and test these strategies at other hospitals and for other conditions.

描述（由申请人提供）：McLeod博士，医学博士，MSCE是儿科医院医学的初级研究员，在临床流行病学和定量分析方面接受过高级培训。她的研究重点是预防儿童脊柱融合手术后手术部位感染（SSI）的干预措施的比较有效性，重点是护理组织背景要素与以患者为中心的结果之间的关联。在本提案的K99部分，McLeod博士描述了一个多学科的职业发展计划，该计划将建立在她现有的技能基础上，并将提供定性和混合方法研究，准实验研究设计和实施科学方面的高级培训。所有这些都将有助于她未来作为一名独立的卫生服务调查员取得成功，重点是改善患者的健康状况，以复杂内科和外科疾病住院儿童的结局为中心。 目标1中概述的K99研究计划将使用定量和定性方法来探索医院特定的组织因素，这些因素可以区分SSI预防的高绩效和低绩效（由调整后的SSI率确定）。除了为McLeod博士提供混合方法研究方面的指导和严格培训外，该项目的完成还将产生有关有效实施SSI预防实践的组织障碍和促进者的假设。 然后，这些发现将作为R00提案（目标2）的基础，以独立执行多中心试验，比较低绩效医院现有实施策略的有效性与定制的（由目标1障碍/促进者告知），多学科方法来设计，实施，并评估以患者为中心和患者知情的干预措施，以减少SSI及其可预防的危害。 应用在K99阶段获得的技能和培训，本试验将使用一种新的混合方法，通过以下方式解决先前研究的局限性：（1）允许探索无法单独使用定量方法测量的背景因素，以及（2）在所有阶段涉及家庭对提高儿童护理质量和结果的障碍和促进因素的观点。 为了完成她的转变，McLeod博士组建了一支由医学博士罗恩凯伦（Ron Keren）和著名整形外科医生约翰多尔曼（John Dormans）领导的优秀导师团队，并将继续受益于宾夕法尼亚大学和费城儿童医院提供的丰富资源。重要的是，这项研究将作为使用以患者为中心的综合策略的概念验证，以提高干预措施的实施有效性，以预防儿童手术后的并发症，并将为未来的多中心试验提供信息，以在其他医院和其他条件下实施和测试这些策略。

项目成果

A Comprehensive Unit-based Safety Program to Improve Perioperative Efficiency in Adolescent Idiopathic Scoliosis.

旨在提高青少年特发性脊柱侧凸围手术期效率的基于单位的综合安全计划。

• DOI: 10.1097/bpo.0000000000001992
• 发表时间: 2022
• 期刊: Journal of pediatric orthopedics
• 作者: Raman,DivyaL;Bixby,EliseC;Wang,Kevin;Rossi,Danielle;Ringler,Jennifer;Wiggins,DanielleA;Arora,Sushrut;Delfin,Jema;Guida,SarahJane;McLeod,Lisa;Vitale,MichaelG
• 通讯作者: Vitale,MichaelG