Rapid Understanding of Best Practices in Rural Intensive Care (RUBRIC)

快速了解农村重症监护最佳实践 (RUBRIC)

• 批准号: 10187333
• 负责人: Thomas Sebastian Valley
• 金额: $ 41.87万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10187333
• 关键词: Rapid; Understanding; Best; Practices; Rural

PROJECT SUMMARY/ABSTRACT Background: Nearly 15% of Americans live in rural communities, but only 1% of intensive care unit (ICU) beds are located in those same communities. The COVID-19 pandemic highlighted the dangers of this disparity. Many rural communities were devastated by COVID-19, with rural counties having four of the five highest population-adjusted death rates in the U.S. Thus, there is an urgent need to identify successful approaches to maximize ICU care for rural communities during times of increased healthcare demand, such as COVID-19. The long-term goal of this R01 project (Rapid Understanding of Best Practices in Rural Intensive Care or RUBRIC) is to ensure that critically ill patients in rural communities receive the best possible care during times of pandemic and beyond. The overall objective is to develop a toolkit of strategies used by high-performing rural ICUs and to rapidly disseminate this toolkit to improve ICU care for rural communities. Project Methods: We will use a sequential explanatory mixed methods study to rapidly understand best practices in rural intensive care. First, we will administer a nationwide survey of rural ICUs to characterize adaptations made in response to COVID-19. Next, we will leverage national administrative claims data to estimate the effect of increased healthcare demand due to COVID-19 on survival for acute respiratory failure among rural ICU patients. Finally, we will perform interviews and detailed hospital assessments during site visits at eight rural ICUs (four high- and four low-performing) to define best practices. Unique Features and Innovation: Since limited evidence is available to broadly define and compare rural ICU performance, our study will make unique national comparisons exclusively among rural ICUs. Using a difference-in-differences analysis, we will estimate the effect of increased healthcare demand on rural ICUs, by using heterogeneity in exposure to COVID-19 across rural counties. Anticipated Impact: We will identify strategies used by rural ICUs to adapt to COVID-19, compare the effectiveness of rural ICUs in responding to COVID-19-related healthcare demand, and define best practices of high-performing rural ICUs. To support rural ICUs in anticipation of successive pandemic waves, we will disseminate a report of strategies used by rural ICUs during COVID-19 within six months of this R01 award and will disseminate additional findings every six months. At the study’s completion and as a next step, a toolkit of best practices in rural intensive care will be implemented and tested in a future proposal.

项目摘要/摘要 背景：将近15％的美国人居住在农村社区，但只有1％的重症监护室（ICU）床 位于同一社区。 COVID-19大流行强调了这种差异的危险。 许多农村社区被库维德（Covid-19）摧毁了，农村县有五个最高的四个 在美国，人口调整的死亡率迫切需要确定成功的方法 在医疗保健需求增加的时候，例如COVID-19，最大程度地关注了ICU护理。 这个R01项目的长期目标（对农村重症监护术的最佳实践的快速理解或 标题）是要确保农村社区的重症患者在时间内获得最佳护理 大流行及以后。总体目标是制定高性能使用的策略工具包 农村ICU并迅速传播此工具包，以改善对崎commulity的社区的ICU护理。 项目方法：我们将使用连续剥离的混合方法研究来快速理解最好的理解 农村重症监护的实践。首先，我们将管理一项全国性的农村ICU调查以表征 对COVID-19进行的适应。接下来，我们将利用国家行政索赔数据来 估计COVID-19引起的医疗保健需求增加对急性呼吸衰竭生存的影响 在粗糙的ICU患者中。最后，我们将在网站期间进行访谈和详细的医院评估 访问八个粗糙的ICU（四个高表现和四个低表现）来定义最佳实践。 独特的功能和创新：由于有限的证据可用于广泛定义和比较农村ICU 表现，我们的研究将在农村ICU中仅进行独特的国家比较。使用 差异分析，我们将通过 在跨农村县的Covid-19中使用异质性。 预期的影响：我们将确定Rough Icus使用以适应Covid-19的策略，比较 粗糙的ICU在响应Covid-19与19与COVID相关的医疗保健需求中的有效性，并定义了最佳实践 高性能的农村ICU。为了预期成功的大流行波，我们将 在此R01奖励后的六个月内传播Rough ICU在Covid-19期间使用的策略的报告 并将每六个月传播一次其他发现。在研究的完成和下一步， 在将来的提案中将实施和测试粗糙重症监护的最佳实践工具包。