Implementation Fidelity and Benefits of the Critical Care Pediatric Guideline Adherence and Outcomes Program in Traumatic Brain Injury

创伤性脑损伤重症监护儿科指南依从性和结果计划的实施保真度和益处

基本信息

批准号：
10558724
负责人：
MICHAEL J BELL
金额：
$ 68.12万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-01-01 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10558724
关键词：
Adherence Adoption Argentine Blood Pressure Caring Cessation of life Child Child Care Childhood Clinical Investigator Collaborations Communities Complex Computer Simulation Consolidated Framework for Implementation Research Country Critical Care Data Dedications Development Elements Engineering Foundations Glasgow Outcome Scale Guideline Adherence Guidelines Health Healthcare Systems Hour Hyperventilation Hypoxia Intensive Care Intervention Intracranial Pressure Maps Medical Care Costs Methods Modeling Monitor Outcome Paper Pathway interactions Patient Admission Patient-Focused Outcomes Patients Performance Persons Population Practice Guidelines Process Provider Public Health Randomized, Controlled Trials Recommendation Research Research Infrastructure Research Personnel Site South American Stream System TBI Patients TBI treatment Testing Theoretical Domains framework Translating Traumatic Brain Injury Universities Washington Work acute care care outcomes disability effective therapy effectiveness outcome effectiveness/implementation hybrid evidence base evidence based guidelines implementation fidelity implementation science implementation strategy improved improved outcome innovation integrated care mortality nutrition operation pediatric traumatic brain injury pilot test prevent programs prophylactic response secondary outcome stakeholder perspectives statistics tool trauma centers treatment as usual ventilation

项目摘要

Project Summary/Abstract Traumatic brain injury (TBI) is a public health crisis for children in the US and worldwide. There are no proven therapies to treat TBI, and evidenced-based guidelines have been developed over the past 2 decades to guide best current practices. Yet, implementation strategies are lacking. In prior work, we found that adherence to the TBI guidelines was associated with 6% better outcomes in 5 leading U.S. academic centers. However, TBI guideline adherence remains low and the guidelines have limitations related to recommendation applicability across health care systems and across countries. In response, we developed and pilot tested an innovative multilevel Pediatric Guideline Adherence and Outcomes (PEGASUS) program to increase TBI guideline adherence. Preliminary data show that barriers to TBI guideline adherence are remediable and TBI guideline based intensive care benefits outcomes. This proposal is a collaboration between U.S. and Argentine TBI clinical investigators dedicated to understanding TBI guideline adherence. The overarching aim of this proposal is guided by the Theoretical Domain Framework. We propose to conduct a pragmatic cluster randomized controlled trial of the PEGASUS program (intervention) and to improve TBI guideline adherence (main outcome) in severe pediatric TBI across six Argentine study sites. Using mixed-methods, we propose 3 Specific Aims: 1) Determine the relationship between PEGASUS program implementation and TBI guideline adherence (Aim 1a), and assess system, provider, patient, implementation and guideline factors associated with TBI guideline adherence (Aim 1b), 2) Create a value stream map that readily identifies value added process of care associated with TBI guideline adherence, and 3) Use computer simulation to develop and disseminate a real world best practices blueprint for TBI guideline adherence. This is a necessary advance and a step towards implementing guideline-based TBI care for children who suffer from TBI.

项目概要/摘要创伤性脑损伤 (TBI) 是美国和全世界儿童的一场公共卫生危机。目前还没有经过证实的治疗 TBI 的疗法，并且已制定了基于证据的指南经过过去 20 年的发展，旨在指导当前最佳实践。然而，实施缺乏策略。在之前的工作中，我们发现遵守 TBI 指南是美国 5 个领先学术中心的成果提高了 6%。然而，创伤性脑损伤指南的遵守率仍然很低，并且指南在以下方面存在局限性建议在整个医疗保健系统和各个国家的适用性。在响应，我们开发并试点测试了创新的多层次儿科指南依从性和结果 (PEGASUS) 计划旨在提高 TBI 指南的依从性。初步数据表明，遵守 TBI 指南的障碍是可以克服的，并且 TBI 基于指南的重症监护福利结果。该提案是双方的合作美国和阿根廷 TBI 临床研究人员致力于了解 TBI 指南坚持。该提案的总体目标以理论领域为指导框架。我们建议开展一项务实的整群随机对照试验 PEGASUS 计划（干预）和提高 TBI 指南的遵守率（主要成果）阿根廷六个研究中心的严重儿科创伤性脑损伤。使用混合方法，我们建议 3 具体目标： 1）确定 PEGASUS 程序之间的关系实施和 TBI 指南遵守情况（目标 1a），并评估系统、提供商、与 TBI 指南遵守相关的患者、实施和指南因素（目标 1b), 2) 创建价值流图，轻松识别增值护理流程与 TBI 指南遵守相关，以及 3) 使用计算机模拟来开发和传播现实世界中遵守 TBI 指南的最佳实践蓝图。这是一个为实施基于指南的儿童 TBI 护理提供了必要的进步和一步患有 TBI 的人。