IMPROVE AKI: A Cluster-Randomized Trial of Team-Based Coaching Interventions to IMPROVE Acute Kidney Injury
改善 AKI:基于团队的教练干预改善急性肾损伤的整群随机试验
基本信息
- 批准号:10402326
- 负责人:
- 金额:$ 67.53万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2018
- 资助国家:美国
- 起止时间:2018-07-15 至 2024-05-31
- 项目状态:已结题
- 来源:
- 关键词:Acute Renal Failure with Renal Papillary NecrosisAddressAdverse eventCardiac Catheterization ProceduresCaringCessation of lifeChronic Kidney FailureClinicalCluster randomized trialDiagnosticDiagnostic ProcedureDialysis procedureDoseDyesE-learningEffectivenessEnd stage renal failureEnrollmentEventFeedbackGrantHealthcareHospitalizationHospitalsIV FluidImaging TechniquesIncidenceInjury to KidneyInterventionIntervention TrialKidneyLiquid substanceMeasurementMedical Care TeamMethodsOralPatient CarePatient-Focused OutcomesPatientsPersonsPhasePlug-inPreventionPrevention ProtocolsPrevention strategyProceduresProcessQuality of CareRadioRandomizedRandomized Clinical TrialsReportingResearchRiskSerious Adverse EventSiteStandardizationTechniquesTestingUnited StatesUnited States Agency for Healthcare Research and QualityUnited States Department of Veterans AffairsWorkbasecardiovascular risk factorcare outcomesclinical practicecomparative efficacycostevidence baseimplementation scienceimplementation strategyimplementation trialimprovedimproved outcomeinjury preventionmortalitymultidisciplinarynovelpatient safetypost interventionpreventpreventive interventionrandomized trialrecruitrenal damagetoolvideo coaching
项目摘要
PROJECT SUMMARY
We propose to test the implementation of evidence-based preventive interventions through a Virtual Learning
Collaborative (VLC) with and without the novel use Automated Surveillance Reporting (ASR) intervention to
change clinical practice and improve patient safety in common diagnostic procedures. Over 2 million people in
the United States undergo diagnostic or interventional cardiac catheterization each year. Acute kidney injury
(AKI), a patient safety metric set by the National Quality Forum, occurs in up to 14% of all patients following a
procedure and up to 50% in patients with pre-existing chronic kidney disease (CKD), making AKI the most
prevalent adverse event. Patients developing AKI have an increased risk of serious adverse events. There are
widely accepted interventions to prevent AKI in patients undergoing cardiac catheterization. Our research team
has demonstrated AKI can be prevented in 28% of patients with CKD through a large regional pilot. Our team
has already developed ASR techniques for AKI nationally within the Veterans’ Administration. Based on our
own preliminary studies, we hypothesize the incorporation of an automated plug-in ASR toolkit to provide near-
realtime feedback to front-line care teams will significantly augment both VLC and Technical Assistance (TA)
interventions in implementation trials. Our objective is to conduct a national randomized clinical trial testing the
use of VLC or TA with or without a plug-in ASR toolkit to determine if ASR significantly improves outcomes for
patients undergoing procedures with contrast dye to overcome the inconsistent application of known ways to
prevent AKI. The rationale underlying the project is that ASR could prove to be a plug-in vehicle to improve
patient endpoints in evidence-based preventive interventions in common diagnostic procedures. We plan to
test our hypothesis through the following specific aims in a 2x2 factorial cluster-randomized trial. For all aims,
16 hospitals will be randomized to receive one of the following interventions for 18-months: A) Technical
Assistance (TA);; B) Technical Assistance with Automated Surveillance Reporting (TA+ASR);; C) Virtual
Learning Collaborative (VLC) with team-based coaching (VLC);; and D) Virtual Learning Collaborative with
Automated Surveillance Reporting (VLC+ASR). Specific Aim 1: Compare the efficacy of a VLC and/or ASR
compared to TA to reduce the incidence of AKI. Specific Aim 2: Evaluate the sustained efficacy of VLC and/or
ASR to reduce the incidence of AKI following the intervention period. The interventions proposed use novel
interactive video coaching sessions and ASR as low-cost scalable implementation strategies to prevent a
clinical endpoint (AKI). Eighteen hospitals have agreed to participate and be randomized. We expect the
impact of a plug-in ASR to augment evidence based preventive interventions and VLC could significantly
improve the consistent application of these interventions and implementation trials. In our opinion, our study
will open the door to a new paradigm of implementation science seeking to continuously improve health care.
项目摘要
我们建议通过虚拟学习来测试基于证据的预防干预措施的实施情况。
协作(VLC),有和没有新的使用自动监控报告(ASR)干预,
改变临床实践,提高患者在常见诊断程序中的安全性。
美国每年都要进行诊断性或介入性心导管插入术。急性肾损伤
(AKI),由国家质量论坛设定的患者安全指标,发生在所有患者中的14%,
在既往存在慢性肾病(CKD)的患者中,阿基的发生率高达50%,
发生阿基的患者发生严重不良事件的风险增加。
广泛接受的干预措施,以预防接受心导管插入术的患者发生阿基。我们的研究团队
通过一项大型区域性试点研究,证明了28%的CKD患者可以预防阿基。我们的团队
已经在退伍军人管理局内开发了全国范围内阿基的ASR技术。基于我们的
根据我们自己的初步研究,我们假设在ASR工具包中加入一个自动化的插件,
实时反馈给一线护理团队将大大增强VLC和技术援助(TA)
我们的目标是进行一项全国性的随机临床试验,
使用VLC或TA(带或不带ASR工具包中的插件),以确定ASR是否显著改善了
接受造影剂手术的患者,以克服已知方法的不一致应用,
预防阿基。该项目的基本原理是,ASR可以被证明是一种插入式车辆,
在常见的诊断程序中,基于证据的预防性干预措施的患者终点。我们计划
在2x2析因聚类随机试验中,通过以下特定目标来检验我们的假设。2对于所有目标,
16家医院将随机接受以下干预措施之一,为期18个月:
援助(TA); B)自动监控报告技术援助(TA+ASR); CISC)虚拟
学习协作(VLC)与基于团队的辅导(VLC);
自动监控报告(VLC+ASR)。具体目标1:比较VLC和/或ASR的功效
具体目标2:评价VLC和/或TTA的持续疗效,
ASR以降低干预期后阿基的发生率。
交互式视频辅导课程和ASR作为低成本可扩展的实施策略,
临床终点(阿基)。18家医院已同意参与并随机分配。我们预计,
插入式ASR对增强循证预防干预和VLC的影响可以显著
改善这些干预措施和实施试验的一致应用。在我们看来,我们的研究
将为寻求持续改善医疗保健的实施科学的新范式打开大门。
项目成果
期刊论文数量(8)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Death, coronary revascularization choices, and chronic kidney disease.
死亡、冠状动脉血运重建选择和慢性肾脏疾病。
- DOI:10.1097/mca.0000000000000580
- 发表时间:2018
- 期刊:
- 影响因子:1.8
- 作者:Solomon,RichardJ;Brown,JeremiahR
- 通讯作者:Brown,JeremiahR
Team-Based Coaching Intervention to Improve Contrast-Associated Acute Kidney Injury: A Cluster-Randomized Trial.
以团队为基础的指导干预改善对比相关的急性肾损伤:整群随机试验。
- DOI:10.2215/cjn.0000000000000067
- 发表时间:2023
- 期刊:
- 影响因子:0
- 作者:Brown,JeremiahR;Solomon,Richard;Stabler,MeaganE;Davis,Sharon;Carpenter-Song,Elizabeth;Zubkoff,Lisa;Westerman,DaxM;Dorn,Chad;Cox,KevinC;Minter,Freneka;Jneid,Hani;Currier,JesseW;Athar,SAhmed;Girotra,Saket;Leung,Calvin;Hel
- 通讯作者:Hel
Maintaining a National Acute Kidney Injury Risk Prediction Model to Support Local Quality Benchmarking.
- DOI:10.1161/circoutcomes.121.008635
- 发表时间:2022-08
- 期刊:
- 影响因子:6.9
- 作者:Davis, Sharon E.;Brown, Jeremiah R.;Dorn, Chad;Westerman, Dax;Solomon, Richard J.;Matheny, Michael E.
- 通讯作者:Matheny, Michael E.
The Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society of Extracorporeal Technology Clinical Practice Guidelines for the Prevention of Adult Cardiac Surgery-Associated Acute Kidney Injury.
- DOI:10.1182/ject-54301
- 发表时间:2022-12
- 期刊:
- 影响因子:0
- 作者:Jeremiah R. Brown;L. Shore-lesserson;A. Fox;L. Mongero;K. Lobdell;S. Lemaire;F. de Somer;M. W. V. von Ballmoos;V. Barodka;R. Arora;S. Firestone;R. Solomon;C. Parikh;Kenneth G. Shann;J. Hammon;R. Baker
- 通讯作者:Jeremiah R. Brown;L. Shore-lesserson;A. Fox;L. Mongero;K. Lobdell;S. Lemaire;F. de Somer;M. W. V. von Ballmoos;V. Barodka;R. Arora;S. Firestone;R. Solomon;C. Parikh;Kenneth G. Shann;J. Hammon;R. Baker
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Jeremiah R Brown其他文献
Measuring Neurite Dynamics in Co-culture Using IncuCyte ZOOM ® Live-content Imaging Platform and NeuroLight Red TM Fluorescent Label
使用 IncuCyte ZOOM ® 实时内容成像平台和 NeuroLight Red TM 荧光标签测量共培养中的神经节动态
- DOI:
- 发表时间:
2015 - 期刊:
- 影响因子:0
- 作者:
Jeremiah R Brown;T. Garay;S. Alcantara;Lauren T McGillicuddy;Nevine Holtz;J. Rauch;Dyke;McEwen;V. Groppi;T. Dale;O. McManus - 通讯作者:
O. McManus
Optimizing the pharmacoinvasive approach to acute ST-segment elevation myocardial infarction: use of half-dose thrombolytic therapy in combination with glycoprotein IIb/IIIa receptor inhibitors compared with full-dose thrombolytic therapy in the setting of routine urgent post-thrombolytic percutaneous coronary intervention
- DOI:
10.1016/j.carrev.2010.03.053 - 发表时间:
2010-07-01 - 期刊:
- 影响因子:
- 作者:
Pantila Vanichakarn;Rayson C. Yang;Sheila M. Conley;Tamara A. Anderson;James T. Devries;Bruce J. Friedman;Bruce D. Hettleman;John E. Jayne;Aaron V. Kaplan;John F. Robb;Jeremiah R Brown;Nathaniel W. Niles - 通讯作者:
Nathaniel W. Niles
Jeremiah R Brown的其他文献
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{{ truncateString('Jeremiah R Brown', 18)}}的其他基金
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The BASIC trial: Improving implementation of evidence-based approaches and surveillance to prevent bacterial transmission and infection
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- 批准号:
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