The SIP Study: Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children

SIP 研究：同时实施改善住院儿童哮喘、肺炎和细支气管炎护理的途径

• 批准号: 10656474
• 负责人: Sunitha Vemula Kaiser
• 金额: $ 54.66万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-05 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656474
• 关键词: Adoption; Adult; Antibiotics; Asthma; Bronchiolitis; Caring; Child; Child Care; Childhood; Cluster randomized trial; Community Hospitals; Community Participation; Consolidated Framework for Implementation Research; Data Collection; Dedications; Evidence based practice; Face; Feedback; General Hospitals; Guidelines; Health; Healthcare; Hospitalization; Hospitalized Child; Hospitals; Intensive Care Units; Intervention; Length of Stay; Lung diseases; Measures; Medical; Mentors; Methods; Mission; National Heart, Lung, and Blood Institute; Outcome; Paper; Pathway interactions; Pediatric Hospitals; Pneumonia; Preparation; Protocols documentation; Public Health; Quality of Care; Randomized; Recovery; Research; Resources; Risk; Site; Specific qualifier value; Surveys; Testing; Time; Visit; Visual; Waiting Lists; child services; community setting; comparison control; cost; effectiveness/implementation trial; evidence base; evidence based guidelines; hospital readmission; implementation barriers; implementation evaluation; implementation facilitators; implementation strategy; improved; intervention effect; intervention refinement; multidisciplinary; multilevel analysis; poor health outcome; primary outcome; provider adoption; recruit; respiratory; timeline

PROJECT SUMMARY/ABSTRACT Asthma, pneumonia, and bronchiolitis are the top causes of childhood hospitalization in the US, leading to over 350,000 hospitalizations and ≈$2 billion in costs annually. Poor guideline adoption by clinicians contributes to poor health outcomes for children hospitalized with these respiratory illnesses, including longer recovery time/hospital stay, higher rates of transfer to intensive care units, and increased risk of hospital readmission. General hospitals, such as community hospitals, primarily provide care for adults but also provide care for >70% of hospitalized children nationally. Unlike dedicated children's hospitals, community hospitals face unique challenges to achieving guideline adoption and high-quality care for children, including less access to pediatric services and limited resources for pediatric care and quality improvement. Pathways have been shown to improve clinicians' adoption of evidence-based practices/guidelines and health outcomes for children in community hospitals. Pathways are simple, visual diagrams that guide clinicians step-by-step through the evidence-based care of a specific medical condition (accessed via paper or electronically). Most hospitals implement pathways for a single medical condition at a time, but Seattle Children's Hospital developed an intervention for simultaneously implementing multiple pathways for multiple pediatric conditions. This intervention improved guideline adoption, decreased length of stay, and decreased costs; and these results were sustained. This multi-condition pathway intervention has not yet been studied in community hospitals, which face unique implementation barriers. Our objective is to identify and test pragmatic and sustainable strategies for implementing the multi-condition pathway intervention for children hospitalized with asthma, pneumonia, or bronchiolitis in community hospitals. In Aim 1 (R61), we will engage stakeholders from community hospitals in identifying barriers and facilitators of implementation and in refining the intervention. In Aim 2a (R33), we will conduct a pragmatic, cluster-randomized trial in 36 community hospitals (1:1 randomization to intervention vs. wait-list control) to determine the effects of the multi-condition pathway intervention. Our primary outcome will be adoption of 2 evidence-based practices for each condition over a sustained period of 2 years. We will also determine length of stay, ICU transfer, and readmission. During implementation, we will also measure fidelity (use of implementation strategies as intended) in hospitals receiving the intervention (n=18). In Aim 2b (R33), we will use multi-level models to determine if these strategies are associated with guideline adoption (measured in Aim 2a). Our expected outcomes will be a comprehensive understanding of how to pragmatically, sustainably implement the multi-condition pathway intervention in community hospitals and an assessment of its effects. These outcomes will have an important positive impact by providing evidence on an intervention that can leverage implementation resources by tackling multiple pathways and rapidly improve care and outcomes for children with respiratory illnesses.

项目摘要/摘要 哮喘，肺炎和支气管炎是美国儿童住院的主要原因，导致过度 350,000次住院和约20亿美元的费用。临床医生的指南不良 为患有这些呼吸系统疾病住院的儿童的健康状况不佳，包括 更长的恢复时间/住院时间，更高的转移率转移到重症监护病房以及增加医院的风险 再入院。一般医院，例如社区医院，为成人提供医疗医院，但也提供 在全国范围内照顾> 70％的住院儿童。与敬业的儿童医院不同，社区医院 面临独特的挑战，以实现儿童的指南采用和高质量的护理，包括更少的访问权限 为儿科服务和儿科护理和质量改善的有限资源。途径已经过去了 证明可以改善临床医生对儿童的基于证据的实践/准则和健康成果 在社区医院。途径是简单的视觉图表，可以指导临床医生逐步通过 对特定医疗状况的循证护理（通过纸张或电子方式访问）。大多数医院 一次实施一次医疗状况的途径，但西雅图儿童医院开发了 简单地针对多种小儿条件实施多种途径的干预措施。这 干预改善了指导原则的采用，降低住院时间和成本增加；这些结果 持续了。这种多条件途径干预尚未在社区中研究 医院面临独特的实施障碍。我们的目标是识别和测试务实的 为住院儿童实施多条件途径干预的可持续策略 社区医院中的哮喘，肺炎或支气管炎。在AIM 1（R61）中，我们将与 社区医院在确定实施障碍和促进者方面以及完善干预方面。 AIM 2A（R33），我们将在36家社区医院进行务实的群集随机试验（1：1 随机将干预与等待列表控制）确定多条件途径的效果 干涉。我们的主要结果将是针对每种条件的两种基于证据的实践 持续2年。我们还将确定住院时间，ICU转移和再入院。期间 实施，我们还将衡量医院中的保真度（按预期使用实施策略） 接受干预（n = 18）。在AIM 2B（R33）中，我们将使用多级模型来确定是否这些模型 策略与采用指南有关（在AIM 2A中衡量）。我们的预期结果将是 全面了解如何务实，可持续地实施多条件途径 干预社区医院及其影响的评估。这些结果将有一个重要的 通过提供可以通过干预措施提供证据的积极影响，该干预措施可以利用实施资源 解决多种途径，并迅速改善呼吸道疾病儿童的护理和结果。