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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health impairments that are initiated and/or exacerbated by known racial and socioeconomic health disparities and outdated intensive care unit (ICU) mechanical ventilation and symptom management practices.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.

项目总结