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Adapting and testing a deimplementation program in the Intensive Care Unit

在重症监护病房调整和测试取消计划

基本信息

批准号：
10545049
负责人：
ENYO ABLORDEPPEY
金额：
$ 15.76万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-01 至 2025-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10545049
关键词：
Accident and Emergency department Address Adoption Area Behavior Behavioral Behavioral Mechanisms Caring Case Study Catheters Chest Clinical Clinical Research Clinical effectiveness Cost Effectiveness Analysis Critical Care Critical Illness Data Deimplementation Disease Dose Electronic Health Record Elements Ensure Environment Equipment Evidence based practice Exclusion Focus Groups Frequencies Future Gatekeeping Goals Health Healthcare Healthcare Systems Hospitals Image Incentives Individual Intensive Care Units Intervention Interview K-Series Research Career Programs Life Literature Measures Medical Medicine Mentored Research Scientist Development Award Mentorship Methodology Methods Modeling Motivation National Heart, Lung, and Blood Institute Operative Surgical Procedures Pathway interactions Patient Care Patients Perception Pilot Projects Pneumothorax Policies Positioning Attribute Process Program Effectiveness Protocols documentation Provider Public Health Qualitative Research Research Resources Sample Size Science Services Strategic vision Structure Surveys Testing Thoracic Radiography Training United States Universities Venous Washington Work absorption acute care behavior change behavioral construct career cost effectiveness design dissemination science effectiveness evaluation effectiveness measure effectiveness outcome evidence base experience hospital organization implementation evaluation implementation outcomes implementation research implementation science improved innovation insight intervention mapping intervention program personalized care point of care programs radiologist research study success successful intervention theories trial design ultrasound

项目摘要

PROJECT SUMMARY/ ABSTRACT The goal of the K-award is to position the candidate on the pathway to independent research study. Although the applicant has some training in dissemination and implementation science, which provided preliminary data for her current proposal, the applicant needs to acquire higher level implementation methodology training to propel her towards career independence. The applicant’s goal is to optimize care for critically ill patients through implementation and deimplementation approaches that achieve systematic absorption of evidence-based innovations. There are several areas of critical care medicine in need of implementation principles to close the evidence-to-practice gap that exist. For example, there are millions of critically ill patients annually who require imaging confirmation after central venous catheter insertion. Emerging literature demonstrates that ultrasound is a faster alternative to historical chest xray, thus serving as the ideal confirmation for catheter use. When able to confirm catheter position, ultrasound decreases the number of unnecessary chest radiographs, cumulative resources (technologist, radiologist, equipment), and patient care delays. However, providers are not adopting this practice. During the candidates previous 2-year K award, she developed and initiated a successful evidence- based deimplementation program for ultrasound in lieu of chest xray called DRAUP in the Emergency Department. We hypothesize that this deimplementation program, developed from a theory-driven model and guided by the Behavioral Change Wheel framework addresses the foundational constructs of behavior thus should be successful in any environment. In this K01 proposal, the applicant seeks to demonstrate the generalizability of the theory-driven constructs of DRAUP by refining, testing, and determining the mechanism of impact in a new environment. Thus, the applicant proposes a research agenda that aligns with the NHLBI’s strategic vision objection #6 for studies that “optimize clinical and implementation research to improve health and reduce disease.” In Aim 1, the applicant will employ a systematic approach to DRAUP component refinement dosed to the unique context of the Intensive Care Unit. In Aim 2, the applicant seeks to examine effectiveness outcomes and importantly for de-implementation – cost effectiveness of the program. In Aim 3, the applicant seeks to use mixed methods to evaluate the mechanism of impact of the refined program in the new environment. These aims support the applicant’s training plan in which she will receive expert mentorship and training in Intervention Mapping (Training Goal 1); cost effectiveness analysis (Training Goal 2); and mix methods for mechanistic exploration (Training Goal 3) from Drs. Elvin Geng, Richard Griffey, Aimee James, and Derek Brown. Expertise of the mentorship team, along with the academic and training environment of Washington University, will ensure the applicant’s success. Results of this study will be used to support the scientific premise of the deimplementation program, which can be tested in a subsequent multicenter larger trial and transferrable to other critical care medicine evidence-to-practice gaps.

项目摘要/摘要