Rapid Understanding of Best Practices in Rural Intensive Care (RUBRIC)

项目摘要/摘要 背景资料：近15%的美国人居住在农村社区，但只有1%的重症监护病房(ICU)床位 都位于那些相同的社区。新冠肺炎疫情突显了这种差距的危险。 许多农村社区被新冠肺炎摧毁，五个最高的县中有四个是农村 美国的人口调整死亡率。因此，迫切需要找到成功的方法来应对 在医疗保健需求增加的时期，例如新冠肺炎，最大限度地提高对农村社区的ICU护理。 R01项目的长期目标(快速了解农村重症监护或 原则)是确保农村社区的危重病人在 大流行和更远的地方。总体目标是开发一个战略工具包，供高绩效员工使用 并迅速传播这一工具包，以改善对农村社区的重症监护室护理。 项目方法：我们将使用顺序解释性混合方法研究，以快速了解最佳 农村重症监护实践。首先，我们将在全国范围内开展农村ICU调查，以确定 为回应新冠肺炎而做出的改编。接下来，我们将利用国家行政索赔数据来 估计新冠肺炎带来的医疗需求增加对急性呼吸衰竭患者生存的影响 在农村ICU患者中。最后，我们将在现场进行访谈和详细的医院评估 访问8个农村ICU(4个高绩效和4个低绩效)，以确定最佳做法。 特色和创新：由于能够广泛定义和比较农村ICU的证据有限 我们的研究将专门在农村ICU中进行独特的全国比较。使用 差异分析，我们将估计增加的医疗需求对农村ICU的影响，通过 利用农村各县接触新冠肺炎的异质性。 预期影响：我们将确定农村ICU适应新冠肺炎的战略，比较 农村ICU应对新冠肺炎相关医疗需求的有效性，并确定以下方面的最佳做法 高绩效农村重症监护室。为了支持农村重症监护室以应对接踵而至的大流行浪潮，我们将 在本R01奖颁发后六个月内发布关于农村ICU在新冠肺炎期间使用的策略的报告 并将每六个月发布一次更多的调查结果。在研究完成时，作为下一步， 农村重症监护最佳做法工具包将在未来的提案中实施和测试。

PROJECT SUMMARY/ABSTRACT Background: Nearly 15% of Americans live in rural communities, but only 1% of intensive care unit (ICU) beds are located in those same communities. The COVID-19 pandemic highlighted the dangers of this disparity. Many rural communities were devastated by COVID-19, with rural counties having four of the five highest population-adjusted death rates in the U.S. Thus, there is an urgent need to identify successful approaches to maximize ICU care for rural communities during times of increased healthcare demand, such as COVID-19. The long-term goal of this R01 project (Rapid Understanding of Best Practices in Rural Intensive Care or RUBRIC) is to ensure that critically ill patients in rural communities receive the best possible care during times of pandemic and beyond. The overall objective is to develop a toolkit of strategies used by high-performing rural ICUs and to rapidly disseminate this toolkit to improve ICU care for rural communities. Project Methods: We will use a sequential explanatory mixed methods study to rapidly understand best practices in rural intensive care. First, we will administer a nationwide survey of rural ICUs to characterize adaptations made in response to COVID-19. Next, we will leverage national administrative claims data to estimate the effect of increased healthcare demand due to COVID-19 on survival for acute respiratory failure among rural ICU patients. Finally, we will perform interviews and detailed hospital assessments during site visits at eight rural ICUs (four high- and four low-performing) to define best practices. Unique Features and Innovation: Since limited evidence is available to broadly define and compare rural ICU performance, our study will make unique national comparisons exclusively among rural ICUs. Using a difference-in-differences analysis, we will estimate the effect of increased healthcare demand on rural ICUs, by using heterogeneity in exposure to COVID-19 across rural counties. Anticipated Impact: We will identify strategies used by rural ICUs to adapt to COVID-19, compare the effectiveness of rural ICUs in responding to COVID-19-related healthcare demand, and define best practices of high-performing rural ICUs. To support rural ICUs in anticipation of successive pandemic waves, we will disseminate a report of strategies used by rural ICUs during COVID-19 within six months of this R01 award and will disseminate additional findings every six months. At the study’s completion and as a next step, a toolkit of best practices in rural intensive care will be implemented and tested in a future proposal.