Implementation Core

实施核心

• 批准号: 10709336
• 负责人: Corita R Grudzen
• 金额: $ 98.87万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709336
• 关键词: Accident and Emergency department; Address; Alzheimer' s Disease; Caring; Collaborations; Communication; Communities; Complex; Data; Dementia; Discipline of Nursing; Documentation; Dose; Elderly; Electronic Health Record; Emergency Care; Emergency department visit; Ensure; Frequencies; Goals; Health; Health system; Human Resources; Informatics; Intervention; Lead; Leadership; Measures; Methods; Monitor; Needs Assessment; Nurses; Outcome; Paramedical Personnel; Persons; Physicians; Procedures; Process; Provider; Readiness; Report (document); Research Infrastructure; Research Personnel; Role; Rural; Scientist; Seasons; Site; Social Work; Specific qualifier value; Statistical Data Interpretation; Telephone; Testing; Time; Training; Universities; Wisconsin; Work; acute care; clinical decision support; college; community setting; contextual factors; dementia care; design; experience; implementation barriers; implementation science; implementation strategy; improved; learning network; medical schools; member; peer; peer learning; pilot test; pragmatic trial; success; support tools; tool; usability

PROJECT SUMMARY The primary roles of the Implementation Core are to: 1) harmonize core functions and processes; 2) optimize and integrate clinical decision support; and 3) enable training and intervention fidelity across the three interventions. The Implementation Core Lead, Grudzen (mPI), and the Core Director will oversee harmonization, adaptation, and fidelity monitoring with input from the project leads (Chodosh, Brody, Shah), an implementation scientist (Mittman), qualitative methodologists (Dickson and Arbaje). They will oversee optimization of clinical decision support in collaboration with a lead informatician (Mann). These seasoned collaborators are supported by a rich research infrastructure and personnel with expertise in the implementation of complex health interventions across multiple settings in older adults with serious illness. NYU Grossman School of Medicine, NYU Rory Meyers College of Nursing, University of Wisconsin-Madison, Memorial Sloan Kettering, and the mPI team have substantial expertise in harmonizing core functions of complex interventions, enabling high fidelity across multi-site pragmatic trials in diverse settings, and tailoring usable clinical decision support tools across variable electronic health record (EHR) platforms. To ensure tailoring to local contextual factors across settings, the Implementation Core Steering Committee will engage the Lived Experience Panel and Lived Practice Panel to pre-specify allowable adaptations in form, including the mode of delivery, providers involved, materials or tools needed, dose, and frequency/intensity. Besides overseeing all aspects of the core, the Implementation Core Lead Grudzen and the Core Director will lead strategy to monitor and continually improve implementation. They will first conduct a needs assessment and assess readiness at each site to develop a tailored implementation blueprint. This will include detailed standard operating procedures that describe implementation strategies and how planned and unplanned adaptations will be managed, measured/documented, and reported over time. They will, in coordination with the Administrative Core, oversee the fidelity of each intervention to ensure all core functions are performed during the triadic encounters. Approaches to achieve high fidelity will include pilot testing at multiple sites; identifying nurse, physician, and social work champions at each ED; establishing peer-to-peer learning networks; and using evaluative and iterative tools until fidelity targets are met. Cyclical small tests of change during pilot testing will identify optimal implementation strategies. The lead informatician will direct the processes used to optimize the clinical decision support and ensure that documentation and communication between internal and external members of the care team are both compliant and seamless. A data manager will work with sites to establish their EHR builds and extraction methods. An informatics analyst will ensure data extractions function properly, present data for real-time fidelity monitoring, and package and send data to the Statistical Analysis Core for analyses that may further serve real-time and later outcome analyses.

项目摘要 实施核心的主要作用是：1）协调核心功能和流程; 2）优化 并整合临床决策支持; 3）在三个方面实现培训和干预保真度 干预措施。实施核心负责人Grudzen（mPI）和核心总监将监督 协调、适应和保真度监测，项目负责人（Chodosh、Brody、Shah）的输入， 实施科学家（Mittman），定性方法学家（Dickson和Arbaje）。他们将监督 与首席信息学家（Mann）合作优化临床决策支持。这些经验丰富 合作者得到了丰富的研究基础设施和具有专业知识的人员的支持， 在患有严重疾病的老年人中，在多种情况下实施复杂的健康干预措施。 纽约大学格罗斯曼医学院，纽约大学罗里迈耶斯护理学院，威斯康星大学麦迪逊分校， Memorial Sloan Kettering和mPI团队在协调 复杂的干预措施，在不同环境下的多地点务实试验中实现高保真度， 跨可变电子健康记录（EHR）平台的可用临床决策支持工具。确保 实施核心指导委员会将根据各地的环境因素进行调整， 生活经验小组和生活实践小组，以预先指定形式允许的改编，包括 提供方式、所涉及的提供者、所需的材料或工具、剂量和频率/强度。除了 实施核心领导Grudzen和核心主任将负责监督核心的各个方面， 监测和不断改进执行情况的战略。他们将首先进行需求评估， 评估每个地点的准备情况，以制定量身定制的实施蓝图。这将包括详细的标准 描述实施策略以及计划内和计划外适应如何 随着时间的推移进行管理、测量/记录和报告。他们将与行政当局协调， 核心，监督每个干预的保真度，以确保所有核心功能在三元组期间执行 遭遇实现高保真度的方法包括在多个地点进行试点测试;确定护士， 医生和社会工作冠军在每个艾德;建立对等学习网络;并使用 评估和迭代工具，直到达到保真度目标。试点测试期间的周期性小变化测试将 确定最佳实施战略。首席信息学家将指导用于优化 临床决策支持，并确保内部和外部之间的文件和沟通 护理小组的成员既顺从又天衣无缝。数据经理将与研究中心合作， 他们的EHR构建和提取方法。信息分析师将确保数据提取功能正常， 呈现数据以进行实时保真度监控，并将数据打包并发送到统计分析核心， 分析，可以进一步服务于实时和以后的结果分析。