Improving the efficiency of randomized trials of behavioral interventions for acute and chronic respiratory failure

提高急慢性呼吸衰竭行为干预随机试验的效率

基本信息

批准号：
10219347
负责人：
Scott D Halpern
金额：
$ 11.86万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-05 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10219347
关键词：
Accounting Acute Acute respiratory failure Adherence Adult Adult Respiratory Distress Syndrome Advance Directives Affect American Award Behavior Therapy Caring Chronic Chronic Obstructive Airway Disease Chronic lung disease Clinical Clinical Trials Collaborations Critical Care Data Data Analyses Detection Development Doctor of Philosophy Effectiveness Effectiveness of Interventions Electronic Health Record Enrollment Ethics Evaluation Faculty Feedback Future Goals Grant Guidelines Health Healthcare Systems Heterogeneity Hospitals Human Impairment Incentives Incidence Intervention Knowledge Lead Leadership Learning Lung Lung diseases Machine Learning Measurable Measurement Measures Mechanical ventilation Medicine Mentors Mentorship Methods Midcareer Investigator Award in Patient-Oriented Research Modeling Modernization Natural Language Processing Outcome Patient-Focused Outcomes Patients Physicians Play Postdoctoral Fellow Prevention Principal Investigator Quality of life Randomized Randomized Clinical Trials Records Research Research Infrastructure Research Personnel Respiratory Failure Role Scientist Services Smoke Smoker Structure Techniques Testing Time Training Training Programs Translating Vision Visit Work arm behavior change behavior test behavioral clinical trial behavioral economics behavioral phenotyping career clinical infrastructure clinical trial enrollment comparative efficacy cost design discrete data effectiveness evaluation financial incentive high risk improved improved outcome innovation intervention effect meetings mortality risk next generation novel therapeutics palliative patient oriented patient oriented research personalized approach prevent professor programs randomized trial skills smoking cessation student mentoring treatment effect trial comparing uptake ventilation

项目摘要

The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Scott Halpern to mentor students, residents, post-doctoral fellows, and junior faculty in developing and testing behavioral economic interventions to prevent and improve outcomes following, acute and chronic respiratory failure. Patients with many forms of acute and chronic respiratory failure, such as acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD), respectively, are at high risk of death and suffer considerable short- and long-term impairments in quality of life and functioning. Behavioral interventions, including those informed by behavioral economic principles, hold great promise for preventing these conditions and improving outcomes. Yet the knowledge produced by randomized clinical trials (RCTs) of such interventions is limited due to impediments to patient accrual, patient-centered outcomes ascertainment, and the abilities of traditional analyses to determine which interventions work best for which patients. By leveraging the conceptual models, research infrastructures, and data collected in 5 of Dr. Halpern's ongoing or recently completed RCTs including 40,000 patients, Dr. Halpern and his mentees will develop and test ways to surmount each of these three barriers to producing greater knowledge on how to prevent and treat acute and chronic respiratory failure. First, they will conduct randomized trials of “nudges” to improve enrollment and retention in real RCTs. Second, they will learn and apply state-of-the-art natural language processing and machine learning techniques to enhance the ability to extract patient-centered outcomes from electronic health records, thereby identifying more efficient methods for outcome ascertainment in large, pragmatic RCTs. Third, they will learn and apply modern methods in causal inference and the detection of heterogeneous treatment effects to better understand how effective behavioral interventions are overall, how efficacious they would be if more patients adhered to them, and which interventions work best for which patients. These scientific aims will be completed within the context of a structured training program designed to improve Dr. Halpern's skills in mentoring junior patient-oriented researchers. Dr. Halpern has already successfully mentored more than two dozen patient-oriented researchers. However, by enabling him to reduce his clinical and administrative commitments, this award will increase the time he commits to mentoring, and will improve his mentoring skills by supporting didactic training in influence and leadership and “mentor-the-mentor” meetings with more senior mentors. The award will also enable him to develop a “Junior Faculty Visiting Professor Program in Pulmonary and Critical Care Medicine,” thereby enhancing opportunities for his and other established investigators' mentees to network with other leaders in the field, receive external feedback and mentorship, and gain the confidence that comes with speaking to less familiar audiences.

这项中级护理研究者奖的目标是以患者为导向的研究提高博士的能力。斯科特·哈珀（Scott Halpern 行为经济干预措施，以防止和改善伴随的结果，急性和慢性呼吸失败。患有多种形式的急性和慢性呼吸衰竭的患者，例如急性呼吸窘迫综合征（ARDS）和慢性阻塞性肺疾病（COPD）处于高死亡风险并遭受生活质量和功能的短期和长期障碍。行为干预措施，包括行为经济原则所告知的干预措施，对防止这些条件并改善结果。然而，通过随机临床试验（RCT）产生的知识由于患者准确性的障碍，以患者为中心的确定性，这种干预措施受到限制，传统分析的能力确定哪些干预措施最适合哪些患者。通过利用概念模型，研究基础架构以及Halpern博士正在进行的5个收集的数据或最近完成了包括40,000名患者在内的RCT，Halpern博士和他的Menees将开发和测试方法克服这三个障碍中的每个障碍，以产生如何预防和治疗急性和慢性呼吸衰竭。首先，他们将进行“轻推”的随机试验，以改善入学率和保留在实际RCT中。其次，他们将学习并应用最先进的自然语言处理和机器学习技术以增强从电子健康中提取以患者为中心的结果的能力记录，从而在大型的务实的RCT中识别出更有效的结果确定方法。第三，他们将在因果推理中学习并应用现代方法和异质治疗的检测效果以更好地了解行为干预的有效总体多么有效，如果它们的有效性越来越多的患者坚持他们，哪些干预措施最适合哪些患者。这些科学目标将在旨在改善的结构化培训计划的背景下完成 Halpern博士在以患者为导向的研究人员方面的技能。 Halpern博士已经成功指导了二十多名以患者为导向的研究人员。但是，通过使他能够减少临床和行政承诺，该奖项将增加他致力于心理的时间，并将改善他的心理技能通过支持影响力和领导力的教学培训，并“导师” 与更多高级导师会议。该奖项还将使他能够建立“初级教师来访肺和重症监护医学的教授计划，“从而增加了他和他的机会其他知名的调查人员的梅纳人与该领域的其他领导人建立联系，接收外部反馈和精神训练，并获得与不熟悉的观众交谈所带来的信心。