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

项目摘要 普遍火器伤害和暴力预防咨询的病人已建议由多个 十多年来，全国性组织，但临床医生很少提供这种咨询。执行障碍 必须加以解决，以有效地提供与枪支有关的伤害预防方案。研究团队已经 在酒精筛查、简短干预和 在两个联邦资助的多地点试验中转诊治疗方案。该团队还具有临床专业知识- 基于战略的火器伤害预防和教育计划的发展。我们将应用我们的 实施科学和主题专门知识，以实施普遍预防火器伤害 一项分阶段的倡议：首先在一个单一的城市1级创伤中心，其次在4个创伤中心 中心服务于城市，郊区和农村社区，遵循阶梯楔形方法。所有场地有一台 之前通过约翰霍普金斯临床研究网络合作的成功历史。我们的目标是 展示基于创伤中心的火器伤害预防策略的最佳实践， 储存做法和减少与火器有关的伤亡。这一提案是为响应《巴黎协定》而提交的， 23-066，将完善一个可行的，全面的培训战略，以改善执行普遍的 火器伤预防计划（采用创伤火器安全综合训练） （三）研究其实施情况和效果。在第一阶段，我们将：（主要目标1）证明 采用、实施和维持普遍火器伤害预防方案的可行性 在一个1级创伤中心内进行干预;（次要目标1）评估创伤中心临床医生的火器 伤害预防知识和提供火器伤害预防干预的信心。在第二阶段， 我们的目标是：（主要目标2）增加通用枪支的采用、实施和维护 在约翰霍普金斯医学院的四个参与创伤中心和 临床研究网络，大西洋中部各州的学术和社区医院联盟; （主要目标3）评估火器伤害预防知识，态度和安全储存做法， 在参与的创伤中心治疗的创伤患者;和（次要目标2）评估创伤中心 临床医生的火器伤害预防知识和提供火器伤害预防的信心 干预使用RE-AIM方法，我们将评估我们在各个领域的全面战略 在制度层面的采纳、实施和维护。我们将测量临床医生的枪支安全性 参加临床医生培训后提供枪支预防咨询的知识和信心 通过培训前和培训后的调查来衡量。此外，我们将收集和分析患者数据， 在实施ACTFAST之前和之后，改变知识、态度，最重要的是， 在基线和出院后2周和3个月时的实践。

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.