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.

项目总结。心力衰竭(HF)是一种致命但可治疗的心血管疾病，在 海地和其他低收入国家的农村地区。在海地农村，我从2012年开始在那里工作， 约46%的内科病房入院是由于心力衰竭，住院病死率为11%。问题的一部分是 治疗心力衰竭的循证药物只有21%的时间被使用。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)有能力解读的临床医生是心力衰竭治疗的主要障碍。海地只有17名心脏病专家 人口1100万。低成本、便携式手持式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以负担得起的和可持续的方式培训临床医生 两人都会获取图像并解释调查结果。自2008年以来，我们一直在开发、实施和评估 使用简化的聚焦心脏超声(SFoCUS)方案对中级临床医生进行培训。我们 在卢旺达、利比里亚和马拉维成功地开展了这项培训。然而，培训模式是 资源紧张，需要1对1的学徒方法和心脏病专家培训专家。有限的可用性 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，按照我们的sFoCUS方案培训海地农村的中级临床医生。我们的西雅图团队已经开发出 新型培训工具，包括自行管理的培训模拟器中的视觉指导和图像匹配。这 新颖的模拟器已经在美国的学生和全科医生中成功测试。然而， 在LICS中，将模拟纳入sFoCUS训练中没有进行过研究。因为我们的模拟器显示了真实的患者 根据图像，可以调整课程，使之与海地的心力衰竭流行病学相一致。我们假设 自我管理的、基于模拟的培训干预是可行的、可接受的、高保真的和促进的 在资源匮乏的环境下有效学习超声心动图技能和解释。我们将对此进行测试 通过以下具体目标提出假设。 目标1 ：采用基于模拟器的自我管理培训 针对海地情况的课程。使用Adapt-ITT框架，我们将首先检查当前对 由经过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。 我们将从病理符合海地心力衰竭流行病学的患者那里获得新病例。 目标2 ： 确定基于模拟器的适配方案的实施效果和实施成本 集中力量训练。我们将培训50名使用模拟器的临床医生。在RE-AIM框架指导下，我们将 调查覆盖范围、有效性、采用、实施和维护。我们的主要效力 结果将是诊断准确率的提高：标准化的HF类别的适当分配 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 改善获得心力衰竭诊断方法的机会，以便在海地全境和其他地方传播。