Behavioral Economic and Staffing Strategies To Increase Adoption of the ABCDEF Bundle in the ICU (BEST-ICU)

提高 ICU 中 ABCDEF 捆绑包采用率的行为经济和人员配置策略 (BEST-ICU)

基本信息

批准号：
10650089
负责人：
Michele Christina Balas
金额：
$ 75.55万
依托单位：
UNIVERSITY OF NEBRASKA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-15 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10650089
关键词：
Acceleration Acute Address Adoption Adult Affect Anxiety Behavioral Budgets Caring Clinical Cognitive Collaborations Communities Complex Critical Care Critical Illness Data Delirium Disparity Electronic Health Record Equity Evidence based intervention Evidence based practice Feedback Fostering Functional disorder Goals Health Health Benefit Healthcare Systems Hospital Administrators Hospitals Hybrids Impaired health Impairment Institutionalization Intensive Care Units Intervention Knowledge Length of Stay Literature Mechanical ventilation Methods Mission Morbidity - disease rate Neurocognitive Outcome Outcome Measure Outcome Study Pain Patients Performance Pharmaceutical Preparations Phase Physical therapy Population Practice Management Protocols documentation Psyche structure Public Health Quality Control Race Randomized Registered nurse Research Research Methodology Resources Specialist Survivors Time United States National Institutes of Health Work Workload arm behavioral economics brain dysfunction care delivery clinical decision-making clinically relevant collaboratory compare effectiveness cost disability effectiveness evaluation effectiveness outcome effectiveness/implementation trial electronic data evidence base experience functional decline health care disparity health disparity hospital readmission implementation facilitators implementation research implementation science implementation strategy improved improved outcome member mortality primary outcome safety net social social norm socioeconomics symptom management systems research team-based care theories uptake validation studies

项目摘要

Project Summary Survivors of critical illness frequently experience profound physical, mental, and cognitive health impairments that are initiated and/or exacerbated by known racial and socioeconomic health disparities and outdated intensive care unit (ICU) mechanical ventilation and symptom management practices. This morbidity is potentially preventable through the application of the ABCDEF bundle; a multicomponent, evidence-based intervention to improve team-based care. While consistently proven safe and effective, national ABCDEF bundle performance remains unacceptably low as clinicians continue to struggle with multiple barriers to bundle delivery. The long-term goal of the proposed work is to develop pragmatic and sustainable strategies to increase the delivery of evidence-based practices that lead to improved care for critically ill adults across a variety of healthcare systems, particularly those serving populations with known health disparities (safety net hospitals). Our overall objective is to evaluate two strategies grounded in behavioral economic theory and implementation science to increase ABCDEF bundle adoption. The strategies being evaluated target a variety of ICU team members and known behavioral determinants of bundle performance. The proposed project includes two phases and four aims. In Phase 1 (UG3), we will work with the NIH’s Healthcare System Research Collaboratory Coordinating Center and our community partners to meet key milestones aimed at enhancing and finalizing the implementation strategies and research methods used to facilitate and evaluate the effectiveness of ABCDEF bundle adoption (UG3 Aim 1). In Phase 2 (UH3), we will conduct a pragmatic, stepped-wedge, cluster randomized hybrid type III effectiveness-implementation trial. After creating 6 matched pairs of 12 ICUs from 3 hospitals (N=8,100 patients on mechanical ventilation), we will randomly assign ICUs within each matched pair to receive either real-time audit and feedback (strategy A) or a Registered Nurse (RN) implementation facilitator (strategy B) and each pair to one of six wedges. The aims of the trial are to compare the effectiveness of real-time audit and feedback and RN implementation facilitator on ABCDEF bundle adoption (UH3 Aim 1; primary outcome) and clinical outcomes (i.e., duration of mechanical ventilation; ICU, hospital, and 30-day mortality; ICU and hospital length of stay; days with acute brain dysfunction; discharge disposition, psychoactive medication, and physical therapy utilization; and 30- day hospital readmission) (UH3 Aim 2). Finally, we will identify and describe key stakeholders’ experiences with, and perspectives on, the acceptability and impact on workload of the implementation strategies (UH3 Aim 3). We expect study results will impact the field by developing simple, yet effective, ways of accelerating the reliable uptake of a variety of evidence-based ICU interventions that will address known health disparities in the ICU and ultimately improve the care and outcomes of millions of critically ill adults annually.

项目概要危重疾病的幸存者经常会经历严重的身体、心理和认知健康障碍由已知的种族和社会经济健康差异以及过时的现象引发和/或加剧重症监护病房 (ICU) 机械通气和症状管理实践是这种发病率。通过应用 ABCDEF 捆绑包来预防潜在的可能性；国家 ABCDEF 捆绑方案始终被证明是安全有效的，旨在改善基于团队的护理。由于步兵继续与捆绑交付的多重障碍作斗争，性能仍然低得令人无法接受。拟议工作的长期目标是制定务实且可持续的战略，以增加提供循证实践，改善各种危重成人的护理医疗保健系统，特别是那些为已知健康差距的人群提供服务的系统（安全网我们的总体目标是评估基于行为经济学理论的两种策略和提高 ABCDEF 捆绑包采用率的实施科学正在评估的策略目标是： ICU 团队成员的多样性和捆绑性能的已知行为决定因素。该项目包括两个阶段和四个目标，在第一阶段 (UG3)，我们将与 NIH 的医疗保健系统合作。研究合作协调中心和我们的社区合作伙伴旨在实现关键里程碑加强和最终确定用于促进和评估的战略实施和研究方法 ABCDEF 捆绑包采用的有效性（UG3 目标 1）在第 2 阶段 (UH3)，我们将进行务实的、阶梯楔形、整群随机混合 III 型有效性实施试验创建 6 项后。配对来自 3 家医院的 12 个 ICU（N=8,100 名接受机械通气的患者），我们将随机在每个匹配对中分配 ICU 来接收实时审核和反馈（策略 A）或注册护士 (RN) 实施促进者（策略 B），每对六个楔子之一目标。试验的目的是比较实时审核和反馈以及 RN 实施促进者的有效性 ABCDEF 捆绑包采用（UH3 目标 1；主要结果）和临床结果（即治疗持续时间）机械通气；ICU、住院和 ICU 住院天数；脑功能障碍；出院处置、精神活性药物和物理治疗的使用；以及日间医院再入院）（UH3 目标 2）。最后，我们将确定并描述关键利益相关者的经历。实施战略的可接受性和对工作量的影响以及对此的看法（UH3 目标 3) 我们预计研究结果将通过开发简单而有效的加速方法来影响该领域。可靠地采用各种基于证据的 ICU 干预措施，以解决已知的健康差异并最终改善每年数百万危重成人的护理和结果。