Simulator-Based simplified Focused Cardiac Ultrasound (sFoCUS) Training in Haiti

海地基于模拟器的简化聚焦心脏超声 (sFoCUS) 培训

• 批准号: 10354678
• 负责人: Gene Fazil Kwan
• 金额: $ 31.47万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-23 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10354678
• 关键词: Address; Admission activity; Adoption; Attention; Cardiac; Cardiology; Cardiovascular Diseases; Caring; Categories; Clinic; Data; Development; Devices; Diagnosis; Diagnostic; Disease; Echocardiography; Educational Curriculum; Educational Intervention; Epidemiology; Evidence Based Medicine; Feedback; Fogarty International Center; Goals; Haiti; Haitian; Heart failure; Hospitals; Hour; Hybrids; Image; Image Analysis; Improve Access; Inpatients; Interview; Learning; Liberia; Maintenance; Malawi; Manikins; Measures; Medical; Medical Students; Modeling; Nurses; Pathology; Patient imaging; Patients; Physicians; Population; Positioning Attribute; Protocols documentation; Provider; Public Health; Reach Effectiveness Adoption Implementation and Maintenance; Research; Research Personnel; Resource-limited setting; Resources; Rural; Rwanda; Scanning; Scientist; Self Administration; Site; Specific qualifier value; Standardization; Students; Surveys; Testing; Time; Training; Treatment Failure; Visual; Work; apprenticeship; base; cost; cost estimate; diagnostic accuracy; effectiveness evaluation; effectiveness implementation study; effectiveness outcome; effectiveness study; evidence base; global health; health care delivery; implementation cost; implementation science; improved; innovation; low income country; multiple data sources; novel; portability; rural area; scale up; simulation; skill acquisition; skills; symptomatic improvement; technology validation; tool; ultrasound; usability; ward

PROJECT SUMMARY. Heart failure (HF) is a lethal, yet treatable, cardiovascular disease that is common in rural areas of Haiti and other low-income countries (LICs). In rural Haiti, where I have worked since 2012, ~46% of medical ward admissions are due to HF and inpatient fatality is 11%. Part of the problem is that evidence-based medicines for HF are used only 21% of the time. However, suboptimal treatment cannot be addressed unless we first confront the problem of diagnosis. The lack of access to (1) echocardiography, and (2) clinicians with skills to interpret them are major barriers to HF treatment. Haiti has only 17 cardiologists for a population of 11 million. The advent of low-cost, portable handheld ultrasound devices has the potential to address both of these barriers. Our attention is focused on affordable and sustainable ways to train clinicians to both acquire images and interpret the findings. Since 2008, we have developed, implemented, and evaluated the training of mid-level clinicians using a simplified focused cardiac ultrasound (sFoCUS) protocol. We successfully implemented this training in Rwanda, Liberia, and Malawi. However, the training model is resource-intense requiring a 1-on-1 apprentice approach with cardiologist expert trainers. Limited availability and cost of cardiologists are principal barriers to dissemination. To address this barrier, we propose employing simulators to train mid-level clinicians in rural Haiti in our sFoCUS protocol. Our Seattle team has developed novel training tools including visual guidance and image matching in a self-administered training simulator. This novel simulator has been successfully tested among students and general physicians in the US. However, incorporating simulation into sFoCUS training is unstudied in LICs. Because our simulator displays real patient images, the curriculum can be adjusted to be consistent with the HF epidemiology in Haiti. We hypothesize that a self-administered, simulation-based training intervention is feasible, acceptable, high-fidelity, and promotes effective learning of echocardiography skills and interpretation in low-resourced settings. We will test this hypothesis through the following specific aims. AIM 1 : Adapt a simulator-based self-administered training curriculum for the Haitian context. Using the ADAPT-ITT framework, we will first examine the current use of echocardiography by informally trained Haitian staff, then assess the simulator’s usability and appropriateness. We will obtain new cases from patients with pathology consistent with Haitian HF epidemiology. AIM 2 : Determine the effectiveness and study the implementation & cost of the adapted simulator-based FoCUS training. We will train 50 clinicians using the simulator. Guided by the RE-AIM framework, we will investigate reach, effectiveness, adoption, implementation, and maintenance. Our primary effectiveness outcome will be improvement in diagnostic accuracy: proper HF category assignment of standardized simulation cases. If successful, our study will lead to a feasible and scalable sFoCUS training platform to improve access to HF diagnostics ready for dissemination throughout Haiti and to other LICs.

项目摘要。心力衰竭（HF）是一种致命但可治疗的心血管疾病， 海地和其他低收入国家的农村地区。在海地农村，我从2012年开始工作， 约46%的内科病房入院是由于HF，住院死亡率为11%。部分问题在于 仅21%的时间使用基于证据的HF药物。然而，次优治疗不能 除非我们首先面对诊断的问题。无法获得（1）超声心动图，以及 (2)具有解释它们的技能的临床医生是HF治疗的主要障碍。海地只有17名心脏病专家， 人口1100万。低成本、便携式手持超声设备的出现有可能 解决这两个障碍。我们的注意力集中在负担得起的和可持续的方式来培训临床医生， 两者都获取图像并解释发现。自2008年以来，我们开发、实施和评估了 使用简化的聚焦心脏超声（sFoCUS）协议培训中级临床医生。我们 在卢旺达、利比里亚和马拉维成功开展了这一培训。然而，培训模式是 资源密集型，需要与心脏病专家培训师进行一对一的学徒培训。有限可用性 和心脏病专家的费用是传播的主要障碍。为了解决这一障碍，我们建议采用 模拟器来培训海地农村的中级临床医生使用我们的sFoCUS协议。我们的西雅图团队开发了 新颖的培训工具，包括自我管理培训模拟器中的视觉指导和图像匹配。这 新的模拟器已在美国的学生和普通医生中成功测试。然而，在这方面， 在低收入国家，将模拟纳入sFoCUS培训的研究尚不多见。因为我们的模拟器显示的是真实的病人 图像，课程可以调整，以符合在海地的HF流行病学。我们假设 自我管理的、基于模拟的训练干预是可行的、可接受的、高保真的， 有效学习超声心动图技能和在低资源环境中的解释。我们将测试这个 假设通过以下具体目标。 要求1 ：调整基于模拟器的自我管理培训 海地背景下的课程。使用ADAPT-ITT框架，我们将首先检查 由非正式培训的海地工作人员进行超声心动图检查，然后评估模拟器的可用性和适当性。 我们将从病理学符合海地HF流行病学的患者中获得新病例。 目的2 : 确定有效性，并研究适应的基于模拟器的 Focus培训。我们将使用模拟器培训50名临床医生。在RE-AIM框架的指导下，我们将 调查范围、有效性、采用、实施和维护。我们的主要功效 结果将是诊断准确性的提高：标准化的正确HF类别分配 模拟案例如果成功，我们的研究将导致一个可行的和可扩展的sFoCUS培训平台， 改善获得HF诊断的机会，以便在海地全国和其他低收入国家传播。