Exploring Institutional Variability in Neuro-prognostication for Survivors of Cardiac Arrest

探索心脏骤停幸存者神经预测的机构变异性

• 批准号: 9809019
• 负责人: Sarah M Perman
• 金额: $ 7.78万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9809019
• 关键词: Adopted; Adoption; Affect; American Heart Association; Applications Grants; Attention; Blood Circulation; Cardiac Volume; Cardiopulmonary Resuscitation; Caring; Case Study; Characteristics; Clinical; Collaborations; Coma; Consult; Data; Decision Aid; Decision Making; Do Not Resuscitate Order; Futility; Future; Goals; Guidelines; Heart Arrest; Hospitals; Hour; Individual; Institute of Medicine (U.S.); Institution; Intensive Care Units; Intervention; Interview; Knowledge; Learning; Literature; Mentored Patient-Oriented Research Career Development Award; Methodological Studies; Mission; National Heart, Lung, and Blood Institute; Neurologic; Neurological outcome; Nurses; Organizational Change; Organizational Culture; Outcome; Patients; Perception; Physicians; Practice Guidelines; Process; Protocols documentation; Provider; Recommendation; Registries; Reporting; Research; Research Proposals; Resuscitation; Risk; Rural; Services; Social Workers; Stratification; Structure; Survivors; Time; Translations; Work; base; career development; clinical practice; cohort; design; evidence base; evidence based guidelines; expectation; family support; implementation research; implementation science; implementation strategy; improved; neurological recovery; novel; novel therapeutics; out-of-hospital cardiac arrest; outcome forecast; patient population; pragmatic trial; prognostic; programs; success; surrogate decision maker; tool

PROJECT SUMMARY/ABSTRACT – Exploring Institutional Variability in Neuro-prognostication for Survivors of Cardiac Arrest Survival and neurological recovery after cardiac arrest are highly variable, driven in part by inconsistent hospital care following successful resuscitation. Data from both in- and out-of-hospital cardiac arrest patient populations have shown variable application of evidence based post-cardiac arrest guidelines, including recommendations for delayed neuro-prognostication, defined as at least 72 hours after return of spontaneous circulation. Reasons for lack of provider adoption of these recommendations have included poor knowledge of the current guidelines, perceptions of poor neurologic recovery for post-arrest patients and surrogate decision makers wishes for early prognostication. To that end, our research team has ongoing work to implement a decision aid to support such processes. The purpose of this grant proposal is pre-implementation research to learn about the organizational culture and workflow at hospitals that have variable rates of utilization of early “Do Not Resuscitate” (DNR) orders. This work will uncover potential barriers and facilitators to implementation of a guideline based decision aid and will allow for a better appreciation of the practice of neuro- prognostication for post-cardiac arrest patients in a more generalizable fashion. To support this overall research mission, we propose the following specific aims in this R03 proposal. The first study aim will explore the variability in utilization of early DNR by hospital in a US multi-center registry of in-hospital cardiac arrest. This analysis will provide understanding of how variable institutions are in their application of DNR as a potential surrogate for the practice of neurological prognostication. In Aim 2 of this research proposal, we plan to conduct a qualitative case study of institutions with variable rates of utilization of early DNR, with some centers reporting high utilization and others reporting low utilization. Centers will be purposively targeted that have different characteristics, including rural versus urban, academic versus non-academic and low versus high volume of cardiac arrest patients. We will interview physicians, nurses and social workers to learn about potential facilitators and barriers to the implementation of a decision aid to support families in making decisions for comatose survivors of cardiac arrest. Our overall objective is to improve the practice of guideline concordant decision making for comatose survivors of cardiac arrest that will encourage delayed neuro- prognostication and allow for sufficient time to awaken from cardiac arrest. By learning from cardiac arrest stakeholders at institutions that practice differently, our study team will be able to adapt our implementation strategy to promote better adoption of the decision aid. Results of this proposal will inform future work aimed at improving the quality of decisions made for comatose survivors of cardiac arrest and to improve neurologic outcomes for cardiac arrest survivors.

项目摘要/摘要 – 探索神经预测的机构变异性 心脏骤停的幸存者 心脏骤停后的生存率和神经功能恢复差异很大，部分原因是不一致的 成功复苏后的医院护理数据。来自院内和院外心脏骤停患者的数据。 人们对基于证据的心脏骤停后指南的应用有所不同，包括 延迟神经预测的建议，定义为自发神经恢复后至少 72 小时 供应商未采纳这些建议的原因包括对这些建议的了解不足。 现行指南、对逮捕后患者神经功能恢复不良的看法以及替代决策 为此，我们的研究团队正在努力实施一项计划。 支持此类进程的决策援助。本拨款提案的目的是进行预实施研究。 了解医院的组织文化和工作流程，这些医院的早期利用率各不相同 这项工作将揭示实施“请勿复苏”(DNR) 命令的潜在障碍和促进因素。 基于指南的决策辅助，并将允许更好地理解神经实践 以更普遍的方式对心脏骤停后患者进行预测以支持这一整体。 研究任务，我们在此 R03 提案中提出以下具体目标 第一个研究目标将探讨。 美国多中心院内心脏骤停登记处医院利用早期 DNR 的差异。 该分析将帮助人们了解可变机构在应用 DNR 作为一种方法时的情况如何。 神经学预后实践的潜在替代品 在本研究提案的目标 2 中，我们计划。 对早期 DNR 使用率不同的机构进行定性案例研究，其中一些 报告利用率高的中心和报告利用率低的中心将有目的地针对这些中心。 具有不同的特征，包括农村与城市、学术与非学术、低水平与非学术 我们将采访医生、护士和社会工作者以了解大量心脏骤停患者的情况。 实施支持家庭决策的决策援助的潜在促进因素和障碍 对于心脏骤停的昏迷幸存者，我们的总体目标是改进指南的实践。 为心脏骤停昏迷的幸存者做出一致的决策，这将鼓励延迟的神经 通过从心脏骤停中学习，留出足够的时间从心脏骤停中醒来。 实践不同的机构的利益相关者，我们的研究团队将能够调整我们的实施 促进更好地采用决策援助的战略。该提案的结果将为未来的工作目标提供信息。 提高对心脏骤停昏迷幸存者的决策质量并改善神经系统 心脏骤停幸存者的结果。