A Mixed Methods Evaluation of the Implementation of Prone Positioning in COVID-19 ARDS

对 COVID-19 ARDS 俯卧位实施的混合方法评估

• 批准号: 10311698
• 负责人: Chad Hochberg
• 金额: $ 7.76万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2023-09-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10311698
• 关键词: Mixed; Methods; Evaluation; Implementation; Prone

Project Summary/Abstract Despite decades of research, mortality from the acute respiratory distress syndrome (ARDS) remains high. Recently, ARDS has received increased attention during the coronavirus disease 19 (COVID-19) pandemic, as the majority of patients with COVID-19 requiring intensive care unit (ICU) admission develop ARDS. The resulting increases in patients with this syndrome has highlighted the need to ensure broad and sustained implementation of existing evidence-based interventions (EBIs) for ARDS. One such lifesaving ARDS intervention is prone positioning. While prone position is supported by randomized controlled trials and recommended in ARDS guidelines, historically it has been underutilized. As healthcare delivery has changed rapidly and dramatically during COVID-19, the critical care practice of prone positioning has also evolved. Prior to the pandemic, prone positioning was utilized in 10-15% of appropriate patients, and now during the pandemic is being used in 40-80% of patients depending on the setting. Understanding the mechanisms behind this rapid practice change is key to more broadly implementing prone positioning and other EBIs for ARDS care during the COVID-19 pandemic and beyond. The main objective of this project is to evaluate the factors influencing the increased use of prone positioning during COVID-19. We hypothesize that factors related to organizational changes (e.g., proning teams, proning protocols and staffing levels), provider characteristics (e.g., belief in efficacy, recognition of ARDS) and patient factors (e.g., higher disease severity) led to the marked increases in use of prone positioning during the COVID-19 pandemic. We will use implementation science tools including the Consolidated Framework for Implementation Research (CFIR) to provide a comprehensive mixed methods evaluation of prone positioning during the pandemic. Using a retrospective cohort study of mechanically ventilated patients with COVID-19 ARDS, we will define the frequency of prone positioning in different settings within our health system and evaluate the patient and ICU factors that predict proning use. Using qualitative methods, we will conduct semi- structured interviews with ICU team members to explore the facilitators of and barriers to prone positioning in COVID-19. Finally, we will survey ICU team members across our health system to evaluate the CFIR implementation determinants associated with the implementation outcomes of acceptability, appropriateness, fidelity and sustainability of prone positioning. This work has the potential to inform a broader and sustained implementation of prone positioning as well as increase our understanding of how to rapidly translate therapeutic advances to the bedside of critically ill patients. This research will provide the applicant with the necessary training to develop the skills needed to pursue a career as an independently funded researcher working in the field of implementation science and critical care.

项目概要/摘要 尽管经过数十年的研究，急性呼吸窘迫综合征（ARDS）的死亡率仍然很高 高的。最近，ARDS 在冠状病毒病 19 (COVID-19) 期间受到越来越多的关注 随着大多数需要入住重症监护病房 (ICU) 的 COVID-19 患者的病情发展 ARDS。由此导致的这种综合征患者数量的增加突出表明需要确保广泛和 持续实施针对 ARDS 的现有循证干预措施 (EBI)。一种这样的救生ARDS 干预是俯卧位。虽然俯卧位得到了随机对照试验的支持， ARDS 指南中推荐，但历史上它并未得到充分利用。随着医疗保健服务的改变 在 COVID-19 期间，俯卧位的重症监护实践也发生了迅速而显着的发展。事先的 在大流行期间，10-15％的适当患者采用了俯卧位，而现在在大流行期间 根据具体情况，40-80% 的患者正在使用。了解这种快速发展背后的机制 实践改变是在 ARDS 护理期间更广泛地实施俯卧位和其他 EBI 的关键 COVID-19 大流行及其他情况。 该项目的主要目标是评估影响易爆物品使用增加的因素 COVID-19 期间的定位。我们假设与组织变革相关的因素（例如俯卧 团队、俯卧撑协议和人员配置水平）、提供者特征（例如，对功效的信念、对 ARDS）和患者因素（例如，疾病严重程度较高）导致俯卧位的使用显着增加 在 COVID-19 大流行期间。我们将使用包括综合框架在内的实施科学工具 用于实施研究 (CFIR)，提供俯卧位的综合混合方法评估 疫情期间。对机械通气的 COVID-19 患者进行回顾性队列研究 ARDS，我们将在我们的卫生系统内的不同环境中定义俯卧位的频率， 评估预测俯卧使用的患者和 ICU 因素。使用定性方法，我们将进行半 对 ICU 团队成员进行结构化访谈，探讨俯卧位的促进因素和障碍 新冠肺炎。最后，我们将调查整个医疗系统的 ICU 团队成员，以评估 CFIR 与实施结果相关的实施决定因素包括可接受性、适当性、 俯卧位的保真度和可持续性。这项工作有可能为更广泛和持续的信息提供信息 实施俯卧位并增加我们对如何快速转化治疗的理解 先进到危重病人的床边。 这项研究将为申请人提供必要的培训，以培养追求目标所需的技能 作为一名独立资助的研究人员，从事实施科学和重症监护领域的工作。