The SHAKE Study: Sustaining High-quality Asthma care for Kids Everywhere

SHAKE 研究：为世界各地的儿童提供高质量的哮喘护理

• 批准号: 9978324
• 负责人: Sunitha Vemula Kaiser
• 金额: $ 4.67万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978324
• 关键词: SHAKE; Study; Sustaining; quality; Asthma

PROJECT SUMMARY/ABSTRACT Healthcare providers' face many challenges adhering to evidence-based guidelines, and this contributes to poor health outcomes for the >100,000 children hospitalized with asthma annually in the United States. Successful methods to promote providers' initial adoption of guidelines have been developed, but to date, little research has focused on methods to robustly sustain guideline adherence. Adherence commonly deteriorates after initial implementation resources are removed. This adversely impacts children with asthma, as >70% are cared for in general hospitals, where resources tend to be preferentially allocated to adult care. Pathways (succinct versions of guidelines that provide visual, step-by-step guidance for healthcare providers) improve quality of care for children hospitalized with asthma. Pathway implementation strategies (methods for promoting pathway implementation) have achieved short-term improvements in care of children in general hospitals. However, to reap maximum value from limited implementation resources, we must identify asthma pathway implementation strategies that promote sustained delivery of high-quality care for children in general hospitals. To achieve that objective, this proposal harnesses the “positive deviance” approach, which asserts that identification and examination of higher- and lower-performing hospitals can facilitate the discovery and wide dissemination of strategies to improve care. Specific aim 1 will involve a secondary quantitative analysis of existing data. Multi- level regression models with an interrupted-time series approach will be used to identify hospital-level factors associated with sustainability and hospitals with higher and lower sustainability performance. Sustainability will be defined as maintenance of higher guideline adherence and higher quality of care at 2 years after pathway implementation (long-term benefit) without declines after implementation resources are removed. Outcomes will include length of stay (clinical outcome that reflects time to recovery) and use of metered-dose inhalers (guideline adherence). Specific aim 2 will study the higher- and lower-performing general hospitals identified in Aim 1 using qualitative, constant comparative methods. The ERIC Framework of implementation strategies will be used to develop a semi-structured interview guide for key personnel involved in pathway implementation. This analysis will identify pathway implementation strategies that promote sustainability and important contextual factors that influence their success. This mixed-methods approach will produce a multi-dimensional, comprehensive understanding of how general hospitals can promote sustained delivery of high-quality care for children with asthma. These findings will fill crucial gaps in our understanding of sustainability, enable general hospitals to more effectively target limited resources, and enable us to develop a comparative-effectiveness trial of sustainability interventions. Thus, these findings will have important positive impacts-- they will advance the science of clinical practice improvement, facilitate sustained use of evidence-based guidelines, and improve health care quality for children, an AHRQ priority population.

项目总结/摘要 医疗保健提供者在遵守循证指南方面面临许多挑战，这导致了贫困。 美国每年有超过100，000名哮喘住院儿童的健康结果。成功 促进供应商初步采用指南的方法已经开发出来，但迄今为止，很少有研究 专注于强有力地维持指南遵守的方法。在初始治疗后， 执行资源被删除。这对哮喘儿童产生了不利影响，因为>70%的哮喘儿童在 综合医院，资源往往优先分配给成人护理。路径（简洁版本 为医疗保健提供者提供直观、逐步指导的指南）， 因哮喘住院的儿童。途径实施战略（促进途径的方法 在短期内改善了综合医院对儿童的护理。但要 从有限的实施资源中获得最大价值，我们必须确定哮喘途径的实施 促进在综合医院为儿童持续提供高质量护理的战略。实现这一 目标，这项建议利用“积极的偏离”的方法，其中主张， 对高绩效和低绩效医院的检查可以促进发现和广泛传播 改善护理的战略。具体目标1将涉及对现有数据进行二次定量分析。多重 采用中断时间序列方法的水平回归模型将用于识别医院水平因素 与可持续性和医院的可持续性表现较高和较低。可持续性将 定义为在路径后2年保持较高的指南依从性和较高的护理质量 执行（长期效益）在执行资源被移除后没有下降。成果将 包括住院时间（反映康复时间临床结果）和计量吸入器的使用（准则 坚持）。具体目标2将研究目标1中确定的绩效较高和较低的综合医院， 定性的、持续的比较方法。ERIC实施战略框架将用于 为参与途径实施的关键人员制定半结构化面试指南。该分析 将确定促进可持续性的途径实施战略和重要的背景因素， 影响他们的成功。这种混合方法将产生一个多维度的，全面的 了解综合医院如何能够促进为儿童提供持续的高质量护理， 哮喘这些发现将填补我们对可持续性理解的关键空白，使综合医院能够 更有效地针对有限的资源，使我们能够开发一个比较有效的试验， 可持续性干预。因此，这些发现将产生重要的积极影响-它们将推动 临床实践改进的科学，促进循证指南的持续使用，并提高 儿童保健质量，这是澳大利亚人权问题咨询机构的一个优先群体。