Implementation Core

实施核心

基本信息

批准号：
10709336
负责人：
Corita R Grudzen
金额：
$ 98.87万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
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：
2023-09-15 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10709336
关键词：
Accident and Emergency department Address Alzheimer&apos s Disease Caring Collaborations Communication Communities Complex Data Dementia Discipline of Nursing Documentation Dose Elderly Electronic Health Record Emergency Care Emergency department visit Ensure Frequencies Goals Health Health system Human Resources Informatics Intervention Lead Leadership Measures Methods Monitor Needs Assessment Nurses Outcome Paramedical Personnel Persons Physicians Procedures Process Provider Readiness Report (document)Research Infrastructure Research Personnel Role Rural Scientist Seasons Site Social Work Specific qualifier value Statistical Data Interpretation Telephone Testing Time Training Universities Wisconsin Work acute care clinical decision support college community setting contextual factors dementia care design experience implementation barriers implementation science implementation strategy improved learning network medical schools member peer peer learning pilot test pragmatic trial success support tools tool usability

项目摘要

PROJECT SUMMARY The primary roles of the Implementation Core are to: 1) harmonize core functions and processes; 2) optimize and integrate clinical decision support; and 3) enable training and intervention fidelity across the three interventions. The Implementation Core Lead, Grudzen (mPI), and the Core Director will oversee harmonization, adaptation, and fidelity monitoring with input from the project leads (Chodosh, Brody, Shah), an implementation scientist (Mittman), qualitative methodologists (Dickson and Arbaje). They will oversee optimization of clinical decision support in collaboration with a lead informatician (Mann). These seasoned collaborators are supported by a rich research infrastructure and personnel with expertise in the implementation of complex health interventions across multiple settings in older adults with serious illness. NYU Grossman School of Medicine, NYU Rory Meyers College of Nursing, University of Wisconsin-Madison, Memorial Sloan Kettering, and the mPI team have substantial expertise in harmonizing core functions of complex interventions, enabling high fidelity across multi-site pragmatic trials in diverse settings, and tailoring usable clinical decision support tools across variable electronic health record (EHR) platforms. To ensure tailoring to local contextual factors across settings, the Implementation Core Steering Committee will engage the Lived Experience Panel and Lived Practice Panel to pre-specify allowable adaptations in form, including the mode of delivery, providers involved, materials or tools needed, dose, and frequency/intensity. Besides overseeing all aspects of the core, the Implementation Core Lead Grudzen and the Core Director will lead strategy to monitor and continually improve implementation. They will first conduct a needs assessment and assess readiness at each site to develop a tailored implementation blueprint. This will include detailed standard operating procedures that describe implementation strategies and how planned and unplanned adaptations will be managed, measured/documented, and reported over time. They will, in coordination with the Administrative Core, oversee the fidelity of each intervention to ensure all core functions are performed during the triadic encounters. Approaches to achieve high fidelity will include pilot testing at multiple sites; identifying nurse, physician, and social work champions at each ED; establishing peer-to-peer learning networks; and using evaluative and iterative tools until fidelity targets are met. Cyclical small tests of change during pilot testing will identify optimal implementation strategies. The lead informatician will direct the processes used to optimize the clinical decision support and ensure that documentation and communication between internal and external members of the care team are both compliant and seamless. A data manager will work with sites to establish their EHR builds and extraction methods. An informatics analyst will ensure data extractions function properly, present data for real-time fidelity monitoring, and package and send data to the Statistical Analysis Core for analyses that may further serve real-time and later outcome analyses.

项目概要实施核心的主要作用是： 1) 协调核心职能和流程； 2）优化并整合临床决策支持； 3) 实现三个方面的培训和干预保真度干预措施。实施核心负责人 Grudzen (mPI) 和核心总监将监督根据项目负责人（Chodosh、Brody、Shah）的意见进行协调、适应和保真度监控，实施科学家（Mittman）、定性方法学家（Dickson 和 Arbaje）。他们将监督与首席信息学家 (Mann) 合作优化临床决策支持。这些经验丰富的合作者得到丰富的研究基础设施和具有该领域专业知识的人员的支持在多种环境下对患有严重疾病的老年人实施复杂的健康干预措施。纽约大学格罗斯曼医学院、纽约大学罗里迈耶斯护理学院、威斯康星大学麦迪逊分校、 Memorial Sloan Kettering 和 mPI 团队在协调核心职能方面拥有丰富的专业知识复杂的干预措施，实现不同环境下多地点实用试验的高保真度，并进行定制跨可变电子健康记录 (EHR) 平台的可用临床决策支持工具。为确保根据不同环境下的当地背景因素，实施核心指导委员会将参与生活经验小组和生活实践小组预先指定允许的形式调整，包括交付方式、涉及的提供者、所需的材料或工具、剂量和频率/强度。除了监督核心的各个方面，实施核心领导 Grudzen 和核心总监将领导监督并持续改进实施的战略。他们将首先进行需求评估并评估每个地点的准备情况，以制定量身定制的实施蓝图。这将包括详细的标准描述实施战略以及计划内和计划外的调整如何进行的操作程序随着时间的推移进行管理、测量/记录和报告。他们将与行政部门协调核心，监督每次干预的保真度，以确保所有核心功能在三元期间得到执行遭遇。实现高保真度的方法包括在多个地点进行试点测试；识别护士，每个急诊室的医生和社会工作冠军；建立同侪学习网络；并使用评估和迭代工具，直到达到保真度目标。试点测试期间周期性的小规模变更测试将确定最佳实施策略。首席信息学家将指导用于优化的流程临床决策支持并确保内部和外部之间的记录和沟通护理团队的成员既顺从又无缝。数据经理将与站点合作建立他们的 EHR 构建和提取方法。信息分析师将确保数据提取正常运行，呈现数据以进行实时保真度监控，并将数据打包并发送到统计分析核心以进行实时保真度监控可以进一步服务于实时和后续结果分析的分析。