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）是一种致命但可以治疗的心血管疾病，很常见 海地和其他低收入国家（LIC）的农村地区。自2012年以来我工作的海地农村地区 〜46％的病房入院是由于HF造成的，住院死亡为11％。问题的一部分是 HF的循证药物仅在21％的时间内使用。但是，次优疗法不能是 除非我们首先面对诊断问题，否则要解决。无法获得（1）超声心动图和 （2）具有解释这些技能的临床医生是HF治疗的主要障碍。海地只有17位心脏病专家 人口1100万。低成本，便携式手持式超声设备的冒险可能有可能 解决这两个障碍。我们的注意力集中在负担得起且可持续的方式上，以培训临床医生 两者都获得了图像并解释发现。自2008年以来，我们已经开发，实施和评估了 使用简化的心脏超声（SFOCUS）方案对中级临床医生进行培训。我们 成功地在卢旺达，利比里亚和马拉维实施了这项培训。但是，培训模型是 资源密集型需要与心脏病专家培训师进行一对一的学徒方法。有限的可用性 心脏病学家的成本是传播的主要障碍。为了解决这个障碍，我们建议雇用 在我们的Sfocus方案中，模拟器培训海地农村地区的中级临床医生。我们的西雅图团队已经发展 新颖的培训工具在自我管理的培训模拟器中，包括视觉指导和图像匹配。这 在美国的学生和普通医师中，新颖的模拟器已成功测试。然而， 在LIC中未研究将模拟纳入Sfocus培训中。因为我们的模拟器显示了真正的病人 图像，可以调整课程，以与海地的HF流行病学一致。我们假设这一点 自我管理，基于模拟的训练干预是可行的，可接受的，高保真的，并且促进 在低资源环境中有效学习超声心动图和解释。我们将测试这个 通过以下特定目的假设。 目标1 ：调整基于模拟器的自我管理培训 海地背景的课程。使用Adapt-Itt框架，我们将首先检查当前的使用 超声心动图由非正式培训的海地工作人员进行，然后评估模拟器的可用性和适当性。 我们将从与海地HF流行病学一致的病理学患者那里获得新病例。 目标2 ： 确定有效性和研究基于模拟器的实施和成本 聚焦培训。我们将使用模拟器培训50位临床医生。在Re-Aim框架的指导下，我们将 调查覆盖范围，有效性，采用，实施和维护。我们的主要有效性 结果将改善诊断准确性：适当的HF类别分配标准化 模拟情况。如果成功，我们的研究将导致可行且可扩展的Sfocus培训平台 提高对HF诊断的访问，准备在整个海地和其他LIC中进行传播。