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)

• 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
• 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

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health impairments that are initiated and/or exacerbated by known racial and socioeconomic health disparities and outdated intensive care unit (ICU) mechanical ventilation and symptom management practices.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 危重病的幸存者经常会经历严重的身体、精神和认知健康障碍 由已知的种族和社会经济健康差异引发和/或加剧， 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包可能可以预防;一个多成分的，基于证据的 采取干预措施，改善团队护理。虽然一直被证明是安全和有效的，国家ABCDEF包 性能仍然低得不可接受，因为临床医生继续与捆绑递送的多个障碍作斗争。 拟议工作的长期目标是制定务实和可持续的战略， 提供循证实践，改善对各种重症成人的护理， 医疗保健系统，特别是那些服务于已知健康差异人群的系统（安全网 医院）。我们的总体目标是评估两种基于行为经济学理论的策略， 实施科学，以提高ABCDEF捆绑包的采用率。正在评估的战略的目标是： 各种ICU团队成员和已知的捆绑性能的行为决定因素。拟议 项目分两个阶段和四个目标。在第1阶段（UG 3），我们将与NIH的医疗保健系统合作 研究合作实验室协调中心和我们的社区合作伙伴，以满足关键的里程碑，旨在 加强和最后确定用于促进和评估的执行战略和研究方法 ABCDEF捆绑包采用的有效性（UG 3目标1）。在第二阶段（UH 3），我们将进行务实的、 逐步楔形、整群随机混合III型有效性实施试验。在创建6 来自3家医院的12个ICU的配对（N= 8，100例机械通气患者），我们将随机 在每个匹配对中分配ICU，以接收实时审计和反馈（策略A）或 注册护士（RN）实施促进者（策略B）和六个楔子中的一个。目标 的试验是比较实时审计和反馈的有效性和RN实施促进 关于ABCDEF束采用（UH 3目标1;主要结局）和临床结局（即，持续时间 机械通气; ICU、住院和30天死亡率; ICU和住院时间;急性 脑功能障碍;出院处置、精神活性药物和物理治疗利用;以及30- 日间再入院）（UH 3目标2）。最后，我们将确定并描述关键利益相关者的经验 以及对实施战略的可接受性和对工作量的影响的看法（UH 3 目标3）。我们希望研究结果将通过开发简单而有效的加速方法来影响该领域 可靠地采用各种循证ICU干预措施，以解决已知的健康差异 并最终改善每年数百万重症成年人的护理和结果。