ACTFAST: Urban and Rural Trauma Centers RE-AIM at Firearm Injury Prevention

ACTFAST：城乡创伤中心重新瞄准枪支伤害预防

• 批准号: 10812044
• 负责人: Katherine Hoops
• 金额: $ 80.13万
• 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: 2023-09-20 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812044
• 关键词: Address; Admission activity; Adopted; Adoption; Age; American College of Surgeons; Attitude; Cause of Death; Cessation of life; Clinical; Clinical Research; Collaborations; Community Hospitals; Competence; Counseling; Data; Education; Effectiveness; Electronic Health Record; Elements; Firearms; Foundations; Funding; Future; Goals; Gun injury; Health Professional; Home; Homicide; Hospitals; Injury; Institution; Intervention; Knowledge; Maintenance; Measures; Medicine; Methodology; Modeling; Nurses; Patients; Persons; Phase; Prevention; Prevention Research; Prevention approach; Prevention education; Prevention program; Prevention strategy; Program Development; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recording of previous events; Research; Resources; Respondent; Rural; Rural Community; Rural Population; Safety; Sampling; Site; Social Workers; Suburban Population; Suicide; Surveys; Time; Training; Training Programs; Trauma patient; Treatment Protocols; Urban Community; Urban Population; Violence; alcohol screening and brief intervention; brief intervention; clinical care; clinical practice; cohort; effectiveness testing; follow-up; gun violence; implementation barriers; implementation research; implementation science; improved; injured; injury prevention; innovation; mortality; multi-site trial; multidisciplinary; pandemic disease; post intervention; prevent; prevention practice; preventive intervention; programs; protective factors; response; safety practice; screening; screening, brief intervention, referral, and treatment; suburban communities; success; trauma centers; violence prevention

PROJECT SUMMARY Universal firearm injury and violence prevention counseling of patients has been recommended by multiple national organizations for over a decade, yet clinicians rarely deliver this counseling. Implementation barriers must be addressed to effectively deliver firearm related injury prevention programs. The research team has demonstrated success in the implementation and sustainability of alcohol screening, brief intervention and referral to treatment protocols in two federally funded multi-site trials. The team also has expertise in clinically- based strategies for firearm injury prevention and educational program development. We will apply our implementation science and subject matter expertise to implement a universal firearm injury prevention initiative in a phased approach: first at a single, urban level 1 trauma center and second at a cohort of 4 trauma centers serving urban, suburban, and rural communities following a stepped-wedge approach. All sites have a successful history of prior collaboration through the Johns Hopkins Clinical Research Network. Our goal is to demonstrate best practices for trauma center-based firearm injury prevention strategies that promote safe storage practices and reduce firearm related injury and death. This proposal, submitted in response to PAR- 23-066, will refine a feasible, comprehensive training strategy for improving the implementation of a universal firearm injury prevention program, ACTFAST (Adopting Comprehensive Training for FireArm Safety in Trauma centers), and then study its implementation and effectiveness. In Phase 1 we will: (Primary Aim 1) demonstrate feasibility of a program for adoption, implementation, and maintenance of a universal firearm injury prevention intervention within one level 1 trauma center; and (Secondary Aim 1) evaluate trauma center clinicians’ firearm injury prevention knowledge and confidence in delivering a firearm injury prevention intervention. In Phase 2, we aim to: (Primary Aim 2) increase the adoption, implementation, and maintenance of a universal firearm injury prevention intervention within four participating trauma centers in Johns Hopkins Medicine and the Clinical Research Network, an alliance of academic and community hospitals in the mid-Atlantic states; (Primary Aim 3) assess firearm injury prevention knowledge, attitudes, and safe storage practices among trauma patients treated within participating trauma centers; and (Secondary Aim 2) evaluate trauma center clinicians’ firearm injury prevention knowledge and confidence in delivering a firearm injury prevention intervention. Using the RE-AIM methodology, we will evaluate our comprehensive strategy across the domains of adoption, implementation, and maintenance at the institutional level. We will measure clinician firearm safety knowledge and confidence in delivering firearm prevention counseling after participation in the clinician training program as measured by pre and post training surveys. In addition, we will collect and analyze patient data before and after ACTFAST implementation for changes in knowledge, attitudes and, most importantly, practices at baseline and at 2 weeks and 3 months after hospital discharge.

项目摘要 多次建议对患者进行通用枪支伤害和预防暴力咨询 国家组织已有十多年了，但临床医生很少提供此咨询。实施障碍 必须解决以有效地提供与枪支相关的预防伤害计划。研究小组有 在酒精筛查，简短干预和可持续性方面取得了成功 在两项由联邦资助的多站点试验中转介治疗方案。该团队在临床上也有专业知识 - 基于枪支伤害预防和教育计划发展的策略。我们将应用我们的 实施科学和主题专业知识以实施通用枪支伤害预防 以分阶段的方式进行主动性：首先在一个单一的城市1级创伤中心，第二个在4个创伤的队列中 经过跨越朝鲜的方法，为城市，郊区和农村社区提供服务的中心。所有站点都有一个 通过约翰·霍普金斯临床研究网络的事先合作的成功历史。我们的目标是 展示基于创伤中心的枪支伤害预防策略的最佳实践，以促进安全 储存实践并减少与枪支有关的伤害和死亡。该提议，是为了回应PAR的 23-066将完善可行，全面的培训策略，以改善通用的实施 枪支伤害预防计划，ACTFAST（在创伤中采用枪支安全的全面培训 中心），然后研究其实施和有效性。在第1阶段，我们将：（主要目标1）证明 通用枪支伤害的采用，实施和维护计划的可行性 在一个1级创伤中心内的干预； （次要目标1）评估创伤中心临床医生的枪支 在第2阶段， 我们的目标是：（主要目的2）增加通用枪支的采用，实施和维护 约翰·霍普金斯医学的四个参与创伤中心的伤害预防干预措施和 临床研究网络，是中大西洋州的学术和社区医院联盟； （主要目的3）评估枪支伤害预防知识，吸引力和安全存储习惯 在参与创伤中心接受治疗的创伤患者； （次要目标2）评估创伤中心 临床医生的枪支伤害预防知识和对预防枪支伤害的信心 干涉。使用Re-Aim方法，我们将评估我们跨领域的全面策略 在机构层面采用，实施和维护。我们将衡量临床枪支安全 参与临床培训后，知识和信心在提供枪支预防咨询 通过培训前和培训后调查衡量的程序。此外，我们将收集和分析患者数据 在ACTFAST实施之前和之后，知识更改，与会者以及最重要的是 出院后2周零3个月的基线练习。