Sustainable Implementation of Prone Positioning for the Acute Respiratory Distress Syndrome

持续实施俯卧位治疗急性呼吸窘迫综合征

基本信息

批准号：
10722194
负责人：
Chad Hochberg
金额：
$ 17.87万
依托单位：
JOHNS HOPKINS UNIVERSITY
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：
2023-08-05 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10722194
关键词：
Acute Respiratory Distress Syndrome Adoption Agreement Award Belief COVID-19 COVID-19 pandemic COVID-19 patient COVID-19/ARDS Chad Characteristics Climate Computerized Medical Record Critical Care Data Data Analyses Data Set Development Plans Disease Eligibility Determination Environment Etiology Evidence based practice Face Feedback Foundations Funding Future Gases Goals Guidelines Health system Hospitals Implementation readiness Informatics Intensive Care Units Interdisciplinary Study Intervention Interview Investigation K-Series Research Career Programs Leadership Learning Life Lung Measures Mechanical ventilation Mentors Mentorship Meta-Analysis Methods Monitor Morbidity - disease rate Organization administrative structures Organizational Culture Patient Care Patient-Focused Outcomes Patients Penetration Positioning Attribute Process Prone Position Recommendation Research Research Personnel Respiratory Failure Retrospective cohort study Review Literature Risk Reduction Severities Site Stomach Structure Survey Methodology Surveys Syndrome Testing Time Training Universities Work career career development design efficacy outcomes evidence base experience falls hands on research high risk hospital care implementation evaluation implementation framework implementation intervention implementation science implementation strategy implementation trial improved member mortality mortality risk novel organizational climate organizational readiness pandemic disease primary outcome routine practice sustainability framework uptake

项目摘要

PROJECT SUMMARY/ABSTRACT This career development award will support Chad Hochberg, MD MHS, to become an independent investigator in critical care implementation science. In this award, Dr. Hochberg will build on his prior NHBLI-funded F32 studies investigating the changes in critical care practice that occurred early in the coronavirus disease 19 (COVID-19) pandemic. With this award, he seeks further training in 1) Informatics to monitor and support implementation, 2) Survey methodology, and 3) Developing, adapting, and evaluating implementation strategies for intensive care unit (ICU) implementation trials. To achieve these goals, he has outlined a 5-year career development plan that involves targeted didactics, hands-on research experience, and intensive mentoring. This research and training will be facilitated by the highly supportive training environment at the Johns Hopkins University, and guided by an experienced mentorship team with relevant expertise. Acute respiratory distress syndrome (ARDS) is a common and deadly form of respiratory failure in patients receiving mechanical ventilation. Prone positioning, a key evidence-based practice (EBP) for ARDS, involves positioning patients to lie on their stomachs, facilitating less injurious mechanical ventilation. Despite strong evidence that prone positioning reduces risk of death, it was historically underused. However, during the early COVID-19 pandemic, the use of prone positioning in patients with COVID-19 ARDS drastically increased compared to historic practice. Yet, preliminary data show falling proning rates, and other implementation experience suggests that without active intervention, appropriate use of this life-saving measure will decline. The strategies needed to support the sustainability of prone positioning in ICU practice are unknown. In this K23, Dr. Hochberg will use an established implementation framework, the dynamic sustainability framework, to structure an investigation into the strategies needed to support sustainability of prone positioning in ICU practice. In Aim 1, he will use granular patient-level data combined with staff surveys of ICU implementation climate from the five-hospital Johns Hopkins Health System, and evaluate the associations between the continued use of proning over time with specific patient characteristics and ICU implementation climate domains. In Aim 2, he will further explore the influence of ICU climate and culture on proning processes using a sequential explanatory mixed methods design. Finally, in Aim 3, he will conduct a pilot implementation trial to support further penetration and sustainability of prone positioning in routine ICU practice, and will assess the feasibility, acceptability, and appropriateness of this intervention using validated implementation surveys of ICU staff. This research and training will establish a strong foundation for a career focused on implementation science in critical care, and provide the preliminary data and experience for Dr. Hochberg to conduct a future R01-level multisite intervention to improve the implementation of prone positioning and other EBPs for ARDS.

项目概要/摘要该职业发展奖将支持 MHS 医学博士 Chad Hochberg 成为一名独立调查员在重症监护实施科学中。在这个奖项中，Hochberg 博士将在他之前由 NHBLI 资助的 F32 的基础上进行改进研究调查冠状病毒疾病早期发生的重症监护实践的变化 19 （2019冠状病毒病大流行。凭借此奖项，他寻求在 1) 信息学方面进行进一步培训，以监控和支持实施，2) 调查方法，以及 3) 制定、调整和评估实施重症监护病房 (ICU) 实施试验的策略。为了实现这些目标，他制定了 5 年计划职业发展计划，包括有针对性的教学、实践研究经验和强化指导。该研究和培训将得到高度支持的培训环境的促进约翰霍普金斯大学，并由具有相关专业知识的经验丰富的导师团队指导。急性呼吸窘迫综合征（ARDS）是接受治疗的患者中一种常见且致命的呼吸衰竭形式机械通气。俯卧位是 ARDS 的一项关键循证实践 (EBP)，涉及定位患者俯卧，有利于减少伤害的机械通气。尽管有强有力的证据表明俯卧位可以降低死亡风险，但它在历史上并未得到充分利用。然而，在 COVID-19 早期大流行期间，与之前相比，COVID-19 ARDS 患者采用俯卧位的情况急剧增加历史实践。然而，初步数据显示俯卧率和其他实施经验正在下降表明如果没有积极干预，这种救生措施的适当使用将会下降。这支持 ICU 实践中俯卧位可持续性所需的策略尚不清楚。在这个K23中，霍赫伯格博士将利用既定的实施框架，即动态可持续发展框架，对支持 ICU 俯卧位可持续性所需的策略进行调查实践。在目标 1 中，他将使用详细的患者级别数据并结合 ICU 实施情况的员工调查约翰霍普金斯大学卫生系统的五家医院的气候，并评估之间的关联随着时间的推移，根据特定的患者特征和 ICU 实施环境继续使用俯卧姿势域。在目标 2 中，他将进一步探讨 ICU 气候和文化对俯卧过程的影响顺序解释性混合方法设计。最后，在目标3中，他将进行试点实施试验支持俯卧位在常规 ICU 实践中的进一步渗透和可持续性，并将评估使用经过验证的 ICU 实施调查得出该干预措施的可行性、可接受性和适当性职员。这项研究和培训将为专注于实施的职业奠定坚实的基础为Hochberg博士未来开展重症监护科学工作提供初步数据和经验 R01 级多部位干预，以改善 ARDS 俯卧位和其他 EBP 的实施。