Improving the efficiency of randomized trials of behavioral interventions for acute and chronic respiratory failure

提高急慢性呼吸衰竭行为干预随机试验的效率

• 批准号: 10445277
• 负责人: Scott D Halpern
• 金额: $ 11.72万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10445277
• 关键词: Accounting; Acute; Acute Respiratory Distress Syndrome; Acute respiratory failure; Adherence; Adult; Advance Directives; Affect; American; Award; Behavior Therapy; Caring; Chronic; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Clinical; Clinical Trials; Collaborations; Critical Care; Data; Data Analyses; Detection; Development; Doctor of Philosophy; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Enrollment; Ethics; Evaluation; Faculty; Feedback; Future; Goals; Grant; Guidelines; Health; Healthcare Systems; Heterogeneity; Hospitals; Human; Impairment; Incentives; Incidence; Intervention; Knowledge; Lead; Leadership; Learning; Lung; Lung diseases; Machine Learning; Measurable; Measurement; Measures; Mechanical ventilation; Medicine; Mentors; Mentorship; Methods; Midcareer Investigator Award in Patient-Oriented Research; Modeling; Modernization; Natural Language Processing; Outcome; Patient-Focused Outcomes; Patients; Physicians; Play; Postdoctoral Fellow; Prevention; Principal Investigator; Prognosis; Quality of life; Randomized; Randomized Clinical Trials; Records; Research; Research Infrastructure; Research Personnel; Respiratory Failure; Role; Scientist; Services; Smoke; Smoker; Structure; Techniques; Testing; Time; Training; Training Programs; Translating; Vision; Visit; Work; arm; behavior change; behavior test; behavioral clinical trial; behavioral economics; behavioral phenotyping; career; clinical infrastructure; clinical trial enrollment; comparative efficacy; cost; design; discrete data; effectiveness evaluation; financial incentive; high risk; improved; improved outcome; innovation; intervention effect; meetings; mortality risk; next generation; novel therapeutics; palliative; patient oriented; patient oriented research; personalized approach; prevent; professor; programs; randomized trial; skills; smoking cessation; student mentoring; treatment effect; trial comparing; uptake; ventilation

The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Scott Halpern to mentor students, residents, post-doctoral fellows, and junior faculty in developing and testing behavioral economic interventions to prevent and improve outcomes following, acute and chronic respiratory failure. Patients with many forms of acute and chronic respiratory failure, such as acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD), respectively, are at high risk of death and suffer considerable short- and long-term impairments in quality of life and functioning. Behavioral interventions, including those informed by behavioral economic principles, hold great promise for preventing these conditions and improving outcomes. Yet the knowledge produced by randomized clinical trials (RCTs) of such interventions is limited due to impediments to patient accrual, patient-centered outcomes ascertainment, and the abilities of traditional analyses to determine which interventions work best for which patients. By leveraging the conceptual models, research infrastructures, and data collected in 5 of Dr. Halpern's ongoing or recently completed RCTs including 40,000 patients, Dr. Halpern and his mentees will develop and test ways to surmount each of these three barriers to producing greater knowledge on how to prevent and treat acute and chronic respiratory failure. First, they will conduct randomized trials of “nudges” to improve enrollment and retention in real RCTs. Second, they will learn and apply state-of-the-art natural language processing and machine learning techniques to enhance the ability to extract patient-centered outcomes from electronic health records, thereby identifying more efficient methods for outcome ascertainment in large, pragmatic RCTs. Third, they will learn and apply modern methods in causal inference and the detection of heterogeneous treatment effects to better understand how effective behavioral interventions are overall, how efficacious they would be if more patients adhered to them, and which interventions work best for which patients. These scientific aims will be completed within the context of a structured training program designed to improve Dr. Halpern's skills in mentoring junior patient-oriented researchers. Dr. Halpern has already successfully mentored more than two dozen patient-oriented researchers. However, by enabling him to reduce his clinical and administrative commitments, this award will increase the time he commits to mentoring, and will improve his mentoring skills by supporting didactic training in influence and leadership and “mentor-the-mentor” meetings with more senior mentors. The award will also enable him to develop a “Junior Faculty Visiting Professor Program in Pulmonary and Critical Care Medicine,” thereby enhancing opportunities for his and other established investigators' mentees to network with other leaders in the field, receive external feedback and mentorship, and gain the confidence that comes with speaking to less familiar audiences.

该以患者为导向的研究中的职业中期研究员奖的目标是提高博士的能力。 Scott Halpern 指导学生、住院医师、博士后研究员和初级教师进行开发和测试 行为经济干预措施，以预防和改善急性和慢性呼吸道疾病的结果 患有多种形式的急性和慢性呼吸衰竭的患者，例如急性呼吸窘迫。 综合征（ARDS）和慢性阻塞性肺疾病（COPD）分别具有很高的死亡风险 并在生活质量和行为方面遭受相当大的短期和长期损害。 干预措施，包括那些遵循行为经济学原理的干预措施，对于预防 然而，随机临床试验（RCT）产生的知识。 由于患者累积、以患者为中心的结果确定存在障碍，此类干预措施受到限制， 以及传统分析确定哪些干预措施最适合哪些患者的能力。 通过利用 Halpern 博士正在进行的 5 个项目中收集的概念模型、研究基础设施和数据， 或最近完成的随机对照试验（包括 40,000 名患者），Halpern 博士和他的学员将开发和测试方法 克服这三个障碍，以提供有关如何预防和治疗急性发作的更多知识 首先，他们将进行“助推”随机试验，以提高入学率和治疗效果。 其次，他们将学习和应用最先进的自然语言处理和 机器学习技术可增强从电子医疗中提取以患者为中心的结果的能力 记录，从而在大型、务实的随机对照试验中确定更有效的结果确定方法。 他们将学习并应用现代方法进行因果推理和异质治疗检测 效果，以更好地了解行为干预的总体效果如何，如果 更多的患者坚持使用这些干预措施，以及哪些干预措施对哪些患者最有效。 这些科学目标将在旨在改进的结构化培训计划的背景下完成 Halpern 博士在指导以患者为中心的初级研究人员方面的技能已经取得了成功。 然而，指导了超过两打以患者为导向的研究人员，使他能够减少临床工作。 和行政承诺，该奖项将增加他致力于指导的时间，并将改善 通过支持影响力和领导力方面的教学培训以及“导师导师”来提高他的指导技能 该奖项还将使他能够开展“初级教师访问”活动。 肺科和重症监护医学教授计划”，从而增加了他和 其他既定调查员的受训者与该领域的其他领导者建立联系，接收外部反馈 和指导，并获得与不太熟悉的听众交谈所带来的信心。