Identifying Areas to Improve ICU Outcomes through Provider Variation

确定通过改变医疗服务提供者来改善 ICU 治疗效果的领域

• 批准号: 10571276
• 负责人: Nicholas E Ingraham
• 金额: $ 16.11万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-15 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10571276
• 关键词: Acute respiratory failure; Address; Adherence; Algorithms; American; Area; Award; Breathing; Caring; Clinical Research; Complement; Critical Care; Critical Illness; Curling' s Ulcer; Data; Databases; Day Care; Decision Making; Development; Discipline; Electronic Health Record; Enrollment; Evidence based intervention; Evidence based practice; Funding; Future; Goals; Grant; Guidelines; Harm Reduction; Health system; Hospitalization; Hospitals; Individual; Intensive Care; Intensive Care Units; Intervention; Intervention Trial; Interview; K-Series Research Career Programs; Knowledge; Learning; Length of Stay; Link; Lung; Mechanical ventilation; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Metadata; Methods; Morbidity - disease rate; Nurses; Outcome; Patient-Focused Outcomes; Patients; Pattern; Physicians; Pilot Projects; Policies; Population; Process; Prone Position; Prophylactic treatment; Provider; Qualifying; Qualitative Research; Randomized, Controlled Trials; Research; Research Design; Research Personnel; Retrospective cohort study; Structure; Survivors; Techniques; Testing; Tidal Volume; Time; Training; Variant; Work; blood glucose regulation; care outcomes; care providers; career; design; evidence base; experience; implementation framework; improved; improved outcome; innovation; intervention mapping; mortality; novel; pilot test; programs; prospective; provider adherence; randomized, clinical trials; recruit; skills; therapy design; ventilation; ward

PROJECT SUMMARY/ABSTRACT Over 1 million Americans require mechanical ventilation each year and mortality estimates range from 30-35% with significant variability at the patient, hospital, and regional level. More recently, physicians were found to be associated with mortality in mechanically ventilated patients, adding yet another level of variation. There is little research as to what individual physicians do to cause this variation in outcomes and whether provider practice patterns can be modified to improve outcomes. To date, morbidity and mortality reduction interventions in this population involve ventilation strategies and harm reduction therapies. Despite these interventions being evidence-based and guideline-supported, their use remains highly variable. The potential link between provider-level variability in mortality and population-level variation in evidence-based practice represents a critical knowledge gap. Specifically, there is a need to understand how physicians’ adherence to evidence- based practices vary, the degree to which this results in harm, and what barriers are modifying practice patterns. The candidate's prior work developed a method, using electronic health record metadata, to assign a provider retrospectively and reliably to each patient for each intensive care day. Using these data, provider- level adherence to low tidal volume ventilation strategies significantly varied across a 12-hospital health system. This Career Development Award builds from that work and seeks to achieve three aims, that together, will promote the candidate's long-term goal of developing and testing strategies to increase adherence to evidence-based care and improve acute respiratory failure survivors' outcomes. Specifically, in this award, the candidate seeks to (1) quantify variation among physicians in adherence to evidence-based practices, (2) generate hypotheses about barriers and facilitators to evidence-based practice adherence, and (3) develop and pilot an intervention targeting barriers to evidence-based care. To complete these aims the candidate will perform a retrospective cohort study (Aim 1), perform a mixed-method study enrolling 40 ward-based physicians that care for mechanically ventilated patients (Aim 2), and use an intervention mapping framework to develop and pilot an intervention targeting barriers to low tidal volume ventilation. The hands-on experience he will acquire in completing these three studies using different methods will be complemented by carefully selected didactic coursework and structured mentoring by senior investigators from multiple disciplines. This work will lead to pilot grants and R01 to support a randomized clinical trial of this intervention. Completing this research will build upon the candidate’s past training and will provide him with the protected time and experience to achieve his career goal of becoming a leading, independently funded outcomes researcher focused on conducting studies within learning health systems to improve outcomes among survivors of ARF and other critical illnesses.

项目摘要/摘要 超过100万美国人每年需要机械通风，死亡率估计范围为30-35％ 患者，医院和区域层面有显着可变性。最近，发现医生是 与机械通风患者的死亡率相关，增加了另一种差异。几乎没有 研究个人医生为导致这种结果差异以及提供者实践的研究 可以修改模式以改善结果。迄今为止，发病率和死亡率降低了干预措施 人口参与策略和损害减少疗法。尽管有这些干预措施 基于循证和指导方针的支持，它们的使用仍然很大。潜在的联系 提供者级别的死亡率和人口级别差异的循证实践差异代表 批判知识差距。具体而言，有必要了解医师如何遵守证据 - 基于的实践各不相同，这导致危害的程度以及哪些障碍正在修改实践 模式。候选人的先前工作使用电子健康记录元数据开发了一种方法 在每个重症监护日，提供者对每个患者的回顾性可靠。使用这些数据，提供商 - 在12院健康中，遵守低潮汐量通风策略的水平差异很大 系统。这个职业发展奖是由这项工作建立的，并试图实现三个目标，共同 将促进候选人的长期目标，即制定和测试策略以提高遵守 循证护理并改善急性呼吸衰竭的结果。具体来说，在这个奖项中， 候选人试图（1）量化医生遵守证据实践的变异，（2） 产生有关障碍和促进者遵守循证实践遵守的假设，以及（3）发展和 试行针对循证护理障碍的干预措施。为了完成这些目标，候选人将 进行回顾性队列研究（AIM 1），进行一项混合方法研究，招募40个病房 照顾机械通风患者的医师（AIM 2），并使用干预映射框架 开发和驾驶干预措施，以低潮汐量通风为目标。他的动手经历 使用不同方法完成这三项研究将仔细完成这三项研究 来自多个学科的高级调查员选择的教学课程和结构化指导。这 工作将导致试点拨款和R01支持该干预措施的随机临床试验。完成此操作 研究将以候选人过去的培训为基础，并为他提供受保护的时间和 实现自己的职业目标的经验，即成为领先的，独立资助的成果研究者 专注于在学习卫生系统中进行研究，以改善ARF幸存者的结局 和其他重症疾病。