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

项目总结/摘要 研究背景：近15%的美国人生活在农村社区，但只有1%的重症监护病房（ICU）床位 都位于这些社区。COVID-19疫情凸显了这种差距的危险。 许多农村社区受到COVID-19的破坏，五个最高的县中有四个是农村县 因此，迫切需要确定成功的方法， 在医疗需求增加的时期，如COVID-19，最大限度地为农村社区提供ICU护理。 R01项目的长期目标（快速了解农村重症监护的最佳实践或 RUBRIC）是为了确保农村社区的重症患者在治疗期间得到最好的护理， 大流行病及其他总体目标是开发一套战略，供高绩效企业使用， 农村ICU，并迅速传播这一工具包，以改善农村社区的ICU护理。 项目方法：我们将使用顺序解释混合方法研究，以快速了解最好的 农村重症监护。首先，我们将在全国范围内对农村ICU进行调查， 为应对COVID-19而进行的调整。接下来，我们将利用国家行政索赔数据， 估计COVID-19导致的医疗需求增加对急性呼吸衰竭生存率的影响 农村ICU患者。最后，我们将在现场进行访谈和详细的医院评估， 访问八个农村ICU（四个高绩效和四个低绩效），以确定最佳做法。 独特性和创新：由于可用于广泛定义和比较农村ICU的证据有限 性能，我们的研究将在农村ICU中进行独特的国家比较。使用 差异中的差异分析，我们将通过以下方式估计医疗保健需求增加对农村ICU的影响： 利用农村各县COVID-19暴露的异质性。 预期影响：我们将确定农村ICU用于适应COVID-19的策略，比较 农村ICU在应对COVID-19相关医疗保健需求方面的有效性，并确定 高性能农村ICU。为了支持农村重症监护室应对连续的大流行浪潮，我们将 在R01授予后六个月内发布农村ICU在COVID-19期间使用的策略报告 并将每六个月公布更多的调查结果。在研究完成后，作为下一步， 将在今后的提案中实施和测试农村重症监护最佳做法工具包。

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.