Sustainable Implementation of Prone Positioning for the Acute Respiratory Distress Syndrome

持续实施俯卧位治疗急性呼吸窘迫综合征

• 批准号: 10722194
• 负责人: Chad Hochberg
• 金额: $ 17.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-05 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722194
• 关键词: Acute Respiratory Distress Syndrome; Adoption; Agreement; Award; Belief; COVID-19; COVID-19 pandemic; COVID-19 patient; COVID-19/ARDS; Chad; Characteristics; Climate; Computerized Medical Record; Critical Care; Data; Data Analyses; Data Set; Development Plans; Disease; Eligibility Determination; Environment; Etiology; Evidence based practice; Face; Feedback; Foundations; Funding; Future; Gases; Goals; Guidelines; Health system; Hospitals; Implementation readiness; Informatics; Intensive Care Units; Interdisciplinary Study; Intervention; Interview; Investigation; K-Series Research Career Programs; Leadership; Learning; Life; Lung; Measures; Mechanical ventilation; Mentors; Mentorship; Meta-Analysis; Methods; Monitor; Morbidity - disease rate; Organization administrative structures; Organizational Culture; Patient Care; Patient-Focused Outcomes; Patients; Penetration; Positioning Attribute; Process; Prone Position; Recommendation; Research; Research Personnel; Respiratory Failure; Retrospective cohort study; Review Literature; Risk Reduction; Severities; Site; Stomach; Structure; Survey Methodology; Surveys; Syndrome; Testing; Time; Training; Universities; Work; career; career development; design; efficacy outcomes; evidence base; experience; falls; hands on research; high risk; hospital care; implementation evaluation; implementation framework; implementation intervention; implementation science; implementation strategy; implementation trial; improved; member; mortality; mortality risk; novel; organizational climate; organizational readiness; pandemic disease; primary outcome; routine practice; sustainability framework; uptake

PROJECT SUMMARY/ABSTRACT This career development award will support Chad Hochberg, MD MHS, to become an independent investigator in critical care implementation science. In this award, Dr. Hochberg will build on his prior NHBLI-funded F32 studies investigating the changes in critical care practice that occurred early in the coronavirus disease 19 (COVID-19) pandemic. With this award, he seeks further training in 1) Informatics to monitor and support implementation, 2) Survey methodology, and 3) Developing, adapting, and evaluating implementation strategies for intensive care unit (ICU) implementation trials. To achieve these goals, he has outlined a 5-year career development plan that involves targeted didactics, hands-on research experience, and intensive mentoring. This research and training will be facilitated by the highly supportive training environment at the Johns Hopkins University, and guided by an experienced mentorship team with relevant expertise. Acute respiratory distress syndrome (ARDS) is a common and deadly form of respiratory failure in patients receiving mechanical ventilation. Prone positioning, a key evidence-based practice (EBP) for ARDS, involves positioning patients to lie on their stomachs, facilitating less injurious mechanical ventilation. Despite strong evidence that prone positioning reduces risk of death, it was historically underused. However, during the early COVID-19 pandemic, the use of prone positioning in patients with COVID-19 ARDS drastically increased compared to historic practice. Yet, preliminary data show falling proning rates, and other implementation experience suggests that without active intervention, appropriate use of this life-saving measure will decline. The strategies needed to support the sustainability of prone positioning in ICU practice are unknown. In this K23, Dr. Hochberg will use an established implementation framework, the dynamic sustainability framework, to structure an investigation into the strategies needed to support sustainability of prone positioning in ICU practice. In Aim 1, he will use granular patient-level data combined with staff surveys of ICU implementation climate from the five-hospital Johns Hopkins Health System, and evaluate the associations between the continued use of proning over time with specific patient characteristics and ICU implementation climate domains. In Aim 2, he will further explore the influence of ICU climate and culture on proning processes using a sequential explanatory mixed methods design. Finally, in Aim 3, he will conduct a pilot implementation trial to support further penetration and sustainability of prone positioning in routine ICU practice, and will assess the feasibility, acceptability, and appropriateness of this intervention using validated implementation surveys of ICU staff. This research and training will establish a strong foundation for a career focused on implementation science in critical care, and provide the preliminary data and experience for Dr. Hochberg to conduct a future R01-level multisite intervention to improve the implementation of prone positioning and other EBPs for ARDS.

项目总结/摘要 这个职业发展奖将支持乍得Hochberg，医学博士MHS，成为一个独立的调查员 重症监护实施科学在这个奖项中，Hochberg博士将建立在他以前的NHBLI资助的F32 调查冠状病毒病早期发生的重症监护实践变化的研究19 （COVID-19）疫情。有了这个奖项，他寻求在1）信息学的进一步培训，以监测和支持 实施，2）调查方法，以及3）开发，调整和评估实施 重症监护病房（ICU）实施试验的策略。为了实现这些目标，他提出了一个五年计划。 职业发展计划，涉及有针对性的教学法，实践研究经验， 指导。这一研究和培训将得到高度支持的培训环境的促进， 约翰霍普金斯大学，并由一个经验丰富的导师团队与相关专业知识的指导。急性 呼吸窘迫综合征（ARDS）是一种常见的和致命的呼吸衰竭形式， 机械通气俯卧位是治疗ARDS的关键循证实践（EBP）， 患者可以俯卧，便于进行伤害较小的机械通气。尽管有强有力的证据表明 俯卧位降低了死亡风险，但历史上未得到充分利用。然而，在COVID-19早期， 在大流行期间，COVID-19 ARDS患者使用俯卧位的情况大幅增加， 历史实践。然而，初步数据显示， 这表明，如果不积极干预，这种拯救生命的措施的适当使用将下降。的 支持ICU实践中俯卧位可持续性所需的策略尚不清楚。在K23中， 博士Hochberg将使用一个既定的实施框架，即动态可持续性框架， 对ICU中支持俯卧位可持续性所需的策略进行调查 实践在目标1中，他将使用细粒度的患者级数据，并结合ICU实施的员工调查 气候从五家医院约翰霍普金斯卫生系统，并评估之间的关联 随着特定患者特征和ICU实施环境的变化，持续使用俯卧位 域.在目标2中，他将进一步探索ICU气候和文化对俯卧过程的影响， 序贯解释混合方法设计。最后，在目标3中，他将进行试点实施试验， 支持在ICU常规实践中进一步渗透和持续俯卧位，并将评估 使用经验证的ICU实施调查，评估该干预措施的可行性、可接受性和适当性 工作人员这项研究和培训将为专注于实施的职业生涯奠定坚实的基础 科学在重症监护，并提供初步的数据和经验，为博士Hochberg进行未来 R 01水平多点干预，以改善俯卧位和其他针对ARDS的EBP的实施。