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

通过改变呼吸衰竭实践来促进公平 (PRECIPICE)

基本信息

批准号：
10365559
负责人：
Mari Armstrong-Hough
金额：
$ 72.43万
依托单位：
NEW YORK UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-15 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10365559
关键词：
Activities of Daily Living Address Age American Behavior Belief COVID-19 Caring Cessation of life Characteristics Clinical Clinical Data Cognitive Cohort Studies Communication Communication Barriers Community Hospitals Critical Care Critical Illness Data Ethnic Origin Family Financial Hardship Funding Health Services Research Hispanic Hispanic Populations Hospitals Household Intensive Care Units Intervention Interview Knowledge Literature Measures Methods Modeling Motivation Multicenter Trials National Heart, Lung, and Blood Institute Not Hispanic or Latino Nurses Observational Study Organization administrative structures Outcome Outcome Study Patients Physical Function Physical therapy Physicians Positioning Attribute Process Public Health Quality of life Reporting Research Research Design Research Personnel Resources Respiratory Failure Risk Sedation procedure Severity of illness Site Visit Specific qualifier value Structure Surveys Survivors Testing Time Work arm base behavior change bilingualism care delivery clinical practice cohort comorbidity design disparity elimination experience functional outcomes health disparity health equity improved outcome innovation mortality multidisciplinary patient registry prototype research and development respiratory health secondary analysis sex social determinants sociologist standard of care success therapy design

项目摘要

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.

项目摘要背景：在美国，大约300,000个西班牙裔人会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。有紧急需要识别和补救这种差异的机制。调查团队的初步工作确定的两个潜在机制：呼吸衰竭的西班牙裔患者更可能深与非西班牙裔患者相比死亡率和长期功能结果不良。该提案的总体目标是促进公平通过重症监护病房（ICU）实践的变化，西班牙裔患者的呼吸衰竭患者的结果。特定目的和项目方法：目标1：评估长期功能结果的轨迹西班牙裔和非西班牙裔冲浪者呼吸衰竭。对患者的独特注册表的分析呼吸衰竭将检查六个月死亡率和功能结果的风险调整轨迹 96个西班牙裔和96个匹配非西班牙裔对照患者。 AIM 2：表征呼吸道的护理交付种族失败。美国十个潜水员医院的详细现场就诊将与面试和对ICU临床医生的调查，以了解初步的深层镇静和其他护理过程工作证明，种族可以不同。目标3：改进和试点针对的干预措施不平等的护理交付。该团队的初步干预措施以促进呼吸道保健交付的公平性失败将通过患者，家庭和临床参与进行迭代完善，并在两个美国ICU中进行驾驶。该提案的独特方面：该提案解决了重症监护中持久的问题 - 检测，通过将社会学家与差异研究专家团结在一起，理解和消除差距干预设计具有卫生服务研究专业知识的重症监护物理学。与经验丰富的共同投资者，杰出的国家顾问委员会和严格的混合方法团队设计，PI与应对这一紧迫挑战的独特等同。预期的影响：NHLBI关于解决呼吸健康公平的报告强调了消除没有强有力的证据和干预创新，呼吸健康方面的差异将保持理想设计。这项研究的结果将是有助于不平等的护理交付的特征西班牙裔患者的呼吸衰竭和旨在减轻差异的干预措施的结果。