Promoting Equity via Change in Practice for Respiratory Failure (PRECIPICE)

项目摘要 背景：在美国，每年约有30万西班牙裔个体经历呼吸衰竭。 西班牙裔患者死于呼吸衰竭的可能性是非西班牙裔患者的两倍。目前迫切 需要确定和纠正这种差异的机制。调查小组的初步工作 确定了两个潜在的机制：西班牙裔呼吸衰竭患者更有可能是深呼吸。 镇静剂和不太可能接受物理治疗比非西班牙裔患者，这两者都与 死亡率和不良的长期功能结局。本建议的总体目标是促进公平 通过改变重症监护病房（ICU）的做法，西班牙裔呼吸衰竭患者的结局。 具体目标和项目方法：目标1：评价长期功能结局的轨迹， 西班牙裔和非西班牙裔呼吸衰竭幸存者。一个独特的患者登记系统的分析 呼吸衰竭将检查6个月死亡率和功能结局的风险调整轨迹， 96例西班牙裔和96例匹配的非西班牙裔对照患者。目标2：描述呼吸系统疾病的护理提供 种族的失败。在10家不同的美国医院进行的详细现场访问将与采访相结合， ICU临床医生的调查，以了解提供深度镇静和其他护理过程，初步 工作表明，不同种族适用不同。目标3：完善和试行针对性干预措施 不公平的护理服务。该小组的初步干预，以促进公平的护理提供呼吸道疾病 失败将通过患者、家属和临床医生的参与进行迭代改进，并在两个美国ICU进行试点。 该提案的独特方面：该提案解决了重症监护检测中的一个长期问题， 理解，并消除不平等-通过团结一个社会学家与专业知识的差距研究和 由具有卫生服务研究专业知识的重症监护医生设计干预措施。与 经验丰富的合作研究团队，卓越的国家咨询委员会，以及严格的混合方法 PI的设计独特，能够应对这一紧迫的挑战。 预期影响：NHLBI关于解决呼吸健康公平问题的报告强调消除 如果没有强有力的证据和干预创新，呼吸系统健康的差距仍将是令人向往的 设计这项研究的结果将是一个特点的护理提供有助于不公平的 西班牙裔呼吸衰竭患者的预后和旨在减轻差异的干预措施。

PROJECT SUMMARY Background: Approximately 300,000 Hispanic individuals experience respiratory failure each year in the U.S. Hispanic patients are twice as likely to die from respiratory failure as non-Hispanic patients. There is an urgent need to identify and remediate mechanisms for this disparity. The investigative team’s preliminary work identified two potential mechanisms: Hispanic patients with respiratory failure are more likely to be deeply sedated and less likely to receive physical therapy than non-Hispanic patients, which are both associated with mortality and poor long-term functional outcomes. The overall objective of this proposal is to promote equitable outcomes for Hispanic patients with respiratory failure through changes in intensive care unit (ICU) practice. Specific Aims and Project Methods: Aim 1: Evaluate trajectories of long-term functional outcomes for Hispanic and non-Hispanic survivors of respiratory failure. An analysis of a unique registry of patients with respiratory failure will examine risk-adjusted trajectories of six-month mortality and functional outcomes among 96 Hispanic and 96 matched non-Hispanic control patients. Aim 2: Characterize care delivery for respiratory failure by ethnicity. Detailed site visits at ten diverse U.S. hospitals will be integrated with interviews and surveys of ICU clinicians to understand delivery of deep sedation and other care processes that preliminary work demonstrate to be differentially applied by ethnicity. Aim 3: Refine and pilot an intervention targeting inequitable care delivery. The team’s preliminary intervention to promote equity in care delivery for respiratory failure will be iteratively refined through patient, family, and clinician engagement and piloted at two U.S. ICUs. Unique Aspects of this Proposal: This proposal tackles an enduring problem in critical care—detecting, understanding, and eliminating disparities—by uniting a sociologist with expertise in disparities research and intervention design with a critical care physician with expertise in health services research. With an experienced team of co-investigators, preeminent National Advisory Board, and rigorous mixed-methods design, the PIs are uniquely equipped to address this pressing challenge. Anticipated Impact: NHLBI’s Report on Addressing Respiratory Health Equity emphasizes the elimination of disparities in respiratory health will remain aspirational without robust evidence and innovations in intervention design. The outcome of this study will be a characterization of care delivery contributing to inequitable outcomes among Hispanic patients with respiratory failure and an intervention aimed at mitigating disparities.