Implementation Fidelity and Benefits of the Critical Care Pediatric Guideline Adherence and Outcomes Program in Traumatic Brain Injury

项目摘要/摘要 创伤性脑损伤(TBI)是美国和全世界儿童面临的公共健康危机。 目前还没有经过验证的治疗脑损伤的方法，基于证据的指南已经得到了 在过去20年中发展起来，以指导当前的最佳做法。然而，实施 缺乏战略。在之前的工作中，我们发现对TBI指南的遵守是 在5个美国领先的学术中心取得了6%的更好的成绩。然而，TBI 指南的遵从率仍然很低，并且指南在以下方面存在限制 建议在卫生保健系统和国家之间的适用性。在……里面 作为回应，我们开发并试行了一种创新的多水平儿科指南 坚持和结果(飞马)计划，以增加对TBI指南的遵守。 初步数据显示，遵守TBI指南的障碍是可以补救的，而且TBI 以指南为基础的重症监护福利结果。这项提议是两国之间的合作 美国和阿根廷TBI临床研究人员致力于理解TBI指南 坚持不懈。这项建议的总体目标是以理论领域为指导的 框架。我们建议进行一项务实的整群随机对照试验 飞马计划(干预)和改善对TBI指南的遵守(主要结果) 在六个阿根廷研究地点的严重儿科创伤性脑损伤中。使用混合方法，我们建议 3个具体目标：1)确定飞马计划与 实施和遵守TBI指南(目标1a)，并评估系统、供应商、 与TBI指南遵守(AIM)相关的患者、实施和指南因素 1b)、2)创建可轻松识别增值护理流程的价值流图 与TBI指南的遵守有关，以及3)使用计算机模拟来开发和 发布遵守TBI指南的真实世界最佳实践蓝图。这是一个 对儿童实施以指南为基础的脑损伤护理的必要进展和一步 患有脑外伤的人。

Project Summary/Abstract Traumatic brain injury (TBI) is a public health crisis for children in the US and worldwide. There are no proven therapies to treat TBI, and evidenced-based guidelines have been developed over the past 2 decades to guide best current practices. Yet, implementation strategies are lacking. In prior work, we found that adherence to the TBI guidelines was associated with 6% better outcomes in 5 leading U.S. academic centers. However, TBI guideline adherence remains low and the guidelines have limitations related to recommendation applicability across health care systems and across countries. In response, we developed and pilot tested an innovative multilevel Pediatric Guideline Adherence and Outcomes (PEGASUS) program to increase TBI guideline adherence. Preliminary data show that barriers to TBI guideline adherence are remediable and TBI guideline based intensive care benefits outcomes. This proposal is a collaboration between U.S. and Argentine TBI clinical investigators dedicated to understanding TBI guideline adherence. The overarching aim of this proposal is guided by the Theoretical Domain Framework. We propose to conduct a pragmatic cluster randomized controlled trial of the PEGASUS program (intervention) and to improve TBI guideline adherence (main outcome) in severe pediatric TBI across six Argentine study sites. Using mixed-methods, we propose 3 Specific Aims: 1) Determine the relationship between PEGASUS program implementation and TBI guideline adherence (Aim 1a), and assess system, provider, patient, implementation and guideline factors associated with TBI guideline adherence (Aim 1b), 2) Create a value stream map that readily identifies value added process of care associated with TBI guideline adherence, and 3) Use computer simulation to develop and disseminate a real world best practices blueprint for TBI guideline adherence. This is a necessary advance and a step towards implementing guideline-based TBI care for children who suffer from TBI.