ACTFAST: Urban and Rural Trauma Centers RE-AIM at Firearm Injury Prevention

ACTFAST：城乡创伤中心重新瞄准枪支伤害预防

• 批准号: 10812044
• 负责人: Katherine Hoops
• 金额: $ 80.13万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-20 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812044
• 关键词: Address; Admission activity; Adopted; Adoption; Age; American College of Surgeons; Attitude; Cause of Death; Cessation of life; Clinical; Clinical Research; Collaborations; Community Hospitals; Competence; Counseling; Data; Education; Effectiveness; Electronic Health Record; Elements; Firearms; Foundations; Funding; Future; Goals; Gun injury; Health Professional; Home; Homicide; Hospitals; Injury; Institution; Intervention; Knowledge; Maintenance; Measures; Medicine; Methodology; Modeling; Nurses; Patients; Persons; Phase; Prevention; Prevention Research; Prevention approach; Prevention education; Prevention program; Prevention strategy; Program Development; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recording of previous events; Research; Resources; Respondent; Rural; Rural Community; Rural Population; Safety; Sampling; Site; Social Workers; Suburban Population; Suicide; Surveys; Time; Training; Training Programs; Trauma patient; Treatment Protocols; Urban Community; Urban Population; Violence; alcohol screening and brief intervention; brief intervention; clinical care; clinical practice; cohort; effectiveness testing; follow-up; gun violence; implementation barriers; implementation research; implementation science; improved; injured; injury prevention; innovation; mortality; multi-site trial; multidisciplinary; pandemic disease; post intervention; prevent; prevention practice; preventive intervention; programs; protective factors; response; safety practice; screening; screening, brief intervention, referral, and treatment; suburban communities; success; trauma centers; violence prevention

PROJECT SUMMARY Universal firearm injury and violence prevention counseling of patients has been recommended by multiple national organizations for over a decade, yet clinicians rarely deliver this counseling. Implementation barriers must be addressed to effectively deliver firearm related injury prevention programs. The research team has demonstrated success in the implementation and sustainability of alcohol screening, brief intervention and referral to treatment protocols in two federally funded multi-site trials. The team also has expertise in clinically- based strategies for firearm injury prevention and educational program development. We will apply our implementation science and subject matter expertise to implement a universal firearm injury prevention initiative in a phased approach: first at a single, urban level 1 trauma center and second at a cohort of 4 trauma centers serving urban, suburban, and rural communities following a stepped-wedge approach. All sites have a successful history of prior collaboration through the Johns Hopkins Clinical Research Network. Our goal is to demonstrate best practices for trauma center-based firearm injury prevention strategies that promote safe storage practices and reduce firearm related injury and death. This proposal, submitted in response to PAR- 23-066, will refine a feasible, comprehensive training strategy for improving the implementation of a universal firearm injury prevention program, ACTFAST (Adopting Comprehensive Training for FireArm Safety in Trauma centers), and then study its implementation and effectiveness. In Phase 1 we will: (Primary Aim 1) demonstrate feasibility of a program for adoption, implementation, and maintenance of a universal firearm injury prevention intervention within one level 1 trauma center; and (Secondary Aim 1) evaluate trauma center clinicians’ firearm injury prevention knowledge and confidence in delivering a firearm injury prevention intervention. In Phase 2, we aim to: (Primary Aim 2) increase the adoption, implementation, and maintenance of a universal firearm injury prevention intervention within four participating trauma centers in Johns Hopkins Medicine and the Clinical Research Network, an alliance of academic and community hospitals in the mid-Atlantic states; (Primary Aim 3) assess firearm injury prevention knowledge, attitudes, and safe storage practices among trauma patients treated within participating trauma centers; and (Secondary Aim 2) evaluate trauma center clinicians’ firearm injury prevention knowledge and confidence in delivering a firearm injury prevention intervention. Using the RE-AIM methodology, we will evaluate our comprehensive strategy across the domains of adoption, implementation, and maintenance at the institutional level. We will measure clinician firearm safety knowledge and confidence in delivering firearm prevention counseling after participation in the clinician training program as measured by pre and post training surveys. In addition, we will collect and analyze patient data before and after ACTFAST implementation for changes in knowledge, attitudes and, most importantly, practices at baseline and at 2 weeks and 3 months after hospital discharge.

项目概要 多个机构建议对患者进行普遍的枪伤和暴力预防咨询 国家组织已有十多年历史，但维权者很少提供这种咨询 实施障碍。 必须解决这一问题，以有效实施枪支相关伤害预防计划。 酒精筛查的实施和可持续性的成功，展示了短暂的干预和 该团队还拥有临床专业知识。 我们将应用我们的枪支伤害预防和教育计划制定策略。 实施科学和主题专业知识，以实施普遍的枪伤预防 采取分阶段的举措：首先在一个单一的城市一级创伤中心，第二次在 4 名创伤中心进行 中心采用阶梯式楔形方法为城市、郊区和农村社区提供服务。 通过约翰·霍普金斯临床研究网络之前的成功合作历史我们的目标是。 展示基于创伤中心的枪械伤害预防策略的最佳实践，以促进安全 该提案是为了响应 PAR-而提交的。 23-066，将完善可行的、全面的培训策略，以改善普遍的实施 枪械伤害预防计划，ACTFAST（采用创伤中枪械安全综合培训） 中心），然后研究其实施和有效性。在第一阶段，我们将：（主要目标 1）展示。 通过、实施和维持普遍枪伤预防方案的可行性 在一个 1 级创伤中心内进行干预；以及（次要目标 1）评估创伤中心老年人的枪支 伤害预防知识和提供枪械伤害预防干预措施的信心 在第二阶段， 我们的目标是：（主要目标 2）增加通用枪支的采用、实施和维护 约翰·霍普金斯大学医学院四个参与创伤中心的伤害预防干预 临床研究网络，大西洋中部各州学术和社区医院的联盟； （主要目标 3）评估人员的枪械伤害预防知识、态度和安全储存实践 在参与的创伤中心接受治疗的创伤患者；以及（次要目标 2）评估创伤中心 指挥官的枪伤预防知识和进行枪伤预防的信心 使用 RE-AIM 方法，我们将评估我们跨领域的综合战略。 我们将衡量临床医生枪支安全。 参加临床医生培训后提供枪支预防咨询的知识和信心 通过培训前和培训后调查衡量的计划。此外，我们将收集和分析患者数据。 ACTFAST 实施前后知识、态度的变化，最重要的是， 在基线以及出院后 2 周和 3 个月进行练习。