Behavioral Economic and Staffing Strategies To Increase Adoption of the ABCDEF Bundle in the ICU (BEST-ICU)

提高 ICU 中 ABCDEF 捆绑包采用率的行为经济和人员配置策略 (BEST-ICU)

基本信息

批准号：
10650089
负责人：
Michele Christina Balas
金额：
$ 75.55万
依托单位：
UNIVERSITY OF NEBRASKA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-15 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10650089
关键词：
Acceleration Acute Address Adoption Adult Affect Anxiety Behavioral Budgets Caring Clinical Cognitive Collaborations Communities Complex Critical Care Critical Illness Data Delirium Disparity Electronic Health Record Equity Evidence based intervention Evidence based practice Feedback Fostering Functional disorder Goals Health Health Benefit Healthcare Systems Hospital Administrators Hospitals Hybrids Impaired health Impairment Institutionalization Intensive Care Units Intervention Knowledge Length of Stay Literature Mechanical ventilation Methods Mission Morbidity - disease rate Neurocognitive Outcome Outcome Measure Outcome Study Pain Patients Performance Pharmaceutical Preparations Phase Physical therapy Population Practice Management Protocols documentation Psyche structure Public Health Quality Control Race Randomized Registered nurse Research Research Methodology Resources Specialist Survivors Time United States National Institutes of Health Work Workload arm behavioral economics brain dysfunction care delivery clinical decision-making clinically relevant collaboratory compare effectiveness cost disability effectiveness evaluation effectiveness outcome effectiveness/implementation trial electronic data evidence base experience functional decline health care disparity health disparity hospital readmission implementation facilitators implementation research implementation science implementation strategy improved improved outcome member mortality primary outcome safety net social social norm socioeconomics symptom management systems research team-based care theories uptake validation studies

项目摘要

Project Summary Survivors of critical illness frequently experience profound physical, mental, and cognitive health impairments that are initiated and/or exacerbated by known racial and socioeconomic health disparities and outdated intensive care unit (ICU) mechanical ventilation and symptom management practices. This morbidity is potentially preventable through the application of the ABCDEF bundle; a multicomponent, evidence-based intervention to improve team-based care. While consistently proven safe and effective, national ABCDEF bundle performance remains unacceptably low as clinicians continue to struggle with multiple barriers to bundle delivery. The long-term goal of the proposed work is to develop pragmatic and sustainable strategies to increase the delivery of evidence-based practices that lead to improved care for critically ill adults across a variety of healthcare systems, particularly those serving populations with known health disparities (safety net hospitals). Our overall objective is to evaluate two strategies grounded in behavioral economic theory and implementation science to increase ABCDEF bundle adoption. The strategies being evaluated target a variety of ICU team members and known behavioral determinants of bundle performance. The proposed project includes two phases and four aims. In Phase 1 (UG3), we will work with the NIH’s Healthcare System Research Collaboratory Coordinating Center and our community partners to meet key milestones aimed at enhancing and finalizing the implementation strategies and research methods used to facilitate and evaluate the effectiveness of ABCDEF bundle adoption (UG3 Aim 1). In Phase 2 (UH3), we will conduct a pragmatic, stepped-wedge, cluster randomized hybrid type III effectiveness-implementation trial. After creating 6 matched pairs of 12 ICUs from 3 hospitals (N=8,100 patients on mechanical ventilation), we will randomly assign ICUs within each matched pair to receive either real-time audit and feedback (strategy A) or a Registered Nurse (RN) implementation facilitator (strategy B) and each pair to one of six wedges. The aims of the trial are to compare the effectiveness of real-time audit and feedback and RN implementation facilitator on ABCDEF bundle adoption (UH3 Aim 1; primary outcome) and clinical outcomes (i.e., duration of mechanical ventilation; ICU, hospital, and 30-day mortality; ICU and hospital length of stay; days with acute brain dysfunction; discharge disposition, psychoactive medication, and physical therapy utilization; and 30- day hospital readmission) (UH3 Aim 2). Finally, we will identify and describe key stakeholders’ experiences with, and perspectives on, the acceptability and impact on workload of the implementation strategies (UH3 Aim 3). We expect study results will impact the field by developing simple, yet effective, ways of accelerating the reliable uptake of a variety of evidence-based ICU interventions that will address known health disparities in the ICU and ultimately improve the care and outcomes of millions of critically ill adults annually.

项目摘要重症疾病的幸存者经常经历严重的身体，精神和认知健康障碍由已知的拉面和社会经济健康分布启动和/或加剧的，并过时重症监护室（ICU）机械通气和症状管理实践。这种发病率是通过应用ABCDEF捆绑包可以预防；多组分，基于证据干预以改善基于团队的护理。国家ABCDEF捆绑包一贯被证明是安全有效的，但随着临床医生继续为捆绑交付的多个障碍而挣扎，性能仍然令人难以置信。拟议工作的长期目标是制定务实和可持续的策略，以增加提供基于循证的实践，从而改善对危重患病成年人的护理医疗保健系统，尤其是那些为拥有已知健康分配的人群服务的系统（安全网医院）。我们的总体目标是评估以行为经济理论为基础的两种策略，实施科学以增加ABCDEF捆绑包的采用。评估目标的策略 ICU团队成员和已知的捆绑绩效行为决定者。提议项目包括两个阶段和四个目标。在第1阶段（UG3）中，我们将与NIH的医疗保健系统合作研究合作协调中心和我们的社区合作伙伴，以满足针对的关键里程碑加强和敲定用于促进和评估的实施策略和研究方法 ABCDEF捆绑包的有效性（UG3 AIM 1）。在第2阶段（UH3）中，我们将进行务实的阶梯间，簇簇随机混合型III型有效性实施试验。创建6之后匹配了3家医院的12个ICU对（n = 8,100例机械通气），我们将随机随机在每个匹配对中分配ICU，以接收实时审核和反馈（策略A）或A 注册护士（RN）实施促进者（策略B）和六个楔子之一。目的该试验的旨在比较实时审计和反馈的有效性以及RN实施促进者关于ABCDEF捆绑包（UH3 AIM 1；主要结果）和临床结果（即持续时间机械通气； ICU，医院和30天死亡率； ICU和住院时间；急性的日子脑功能障碍；排放处置，精神活性药物和物理疗法利用； 30-- 日医院再入院）（UH3 AIM 2）。最后，我们将确定并描述关键利益相关者的经验以及对实施策略工作量的可接受性和影响的观点（UH3）目标3）。我们预计研究结果将通过开发简单但有效的加速方式来影响该领域各种基于证据的ICU干预措施的可靠吸收将解决已知的健康分布在ICU中，最终改善了每年数百万危重的成年人的护理和结果。