Identifying Areas to Improve ICU Outcomes through Provider Variation

确定通过改变医疗服务提供者来改善 ICU 治疗效果的领域

基本信息

批准号：
10571276
负责人：
Nicholas E Ingraham
金额：
$ 16.11万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-12-15 至 2027-11-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10571276
关键词：
Acute respiratory failure Address Adherence Algorithms American Area Award Breathing Caring Clinical Research Complement Critical Care Critical Illness Curling&apos s Ulcer Data Databases Day Care Decision Making Development Discipline Electronic Health Record Enrollment Evidence based intervention Evidence based practice Funding Future Goals Grant Guidelines Harm Reduction Health system Hospitalization Hospitals Individual Intensive Care Intensive Care Units Intervention Intervention Trial Interview K-Series Research Career Programs Knowledge Learning Length of Stay Link Lung Mechanical ventilation Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Metadata Methods Morbidity - disease rate Nurses Outcome Patient-Focused Outcomes Patients Pattern Physicians Pilot Projects Policies Population Process Prone Position Prophylactic treatment Provider Qualifying Qualitative Research Randomized, Controlled Trials Research Research Design Research Personnel Retrospective cohort study Structure Survivors Techniques Testing Tidal Volume Time Training Variant Work blood glucose regulation care outcomes care providers career design evidence base experience implementation framework improved improved outcome innovation intervention mapping mortality novel pilot test programs prospective provider adherence randomized, clinical trials recruit skills therapy design ventilation ward

项目摘要

PROJECT SUMMARY/ABSTRACT Over 1 million Americans require mechanical ventilation each year and mortality estimates range from 30-35% with significant variability at the patient, hospital, and regional level. More recently, physicians were found to be associated with mortality in mechanically ventilated patients, adding yet another level of variation. There is little research as to what individual physicians do to cause this variation in outcomes and whether provider practice patterns can be modified to improve outcomes. To date, morbidity and mortality reduction interventions in this population involve ventilation strategies and harm reduction therapies. Despite these interventions being evidence-based and guideline-supported, their use remains highly variable. The potential link between provider-level variability in mortality and population-level variation in evidence-based practice represents a critical knowledge gap. Specifically, there is a need to understand how physicians’ adherence to evidence- based practices vary, the degree to which this results in harm, and what barriers are modifying practice patterns. The candidate's prior work developed a method, using electronic health record metadata, to assign a provider retrospectively and reliably to each patient for each intensive care day. Using these data, provider- level adherence to low tidal volume ventilation strategies significantly varied across a 12-hospital health system. This Career Development Award builds from that work and seeks to achieve three aims, that together, will promote the candidate's long-term goal of developing and testing strategies to increase adherence to evidence-based care and improve acute respiratory failure survivors' outcomes. Specifically, in this award, the candidate seeks to (1) quantify variation among physicians in adherence to evidence-based practices, (2) generate hypotheses about barriers and facilitators to evidence-based practice adherence, and (3) develop and pilot an intervention targeting barriers to evidence-based care. To complete these aims the candidate will perform a retrospective cohort study (Aim 1), perform a mixed-method study enrolling 40 ward-based physicians that care for mechanically ventilated patients (Aim 2), and use an intervention mapping framework to develop and pilot an intervention targeting barriers to low tidal volume ventilation. The hands-on experience he will acquire in completing these three studies using different methods will be complemented by carefully selected didactic coursework and structured mentoring by senior investigators from multiple disciplines. This work will lead to pilot grants and R01 to support a randomized clinical trial of this intervention. Completing this research will build upon the candidate’s past training and will provide him with the protected time and experience to achieve his career goal of becoming a leading, independently funded outcomes researcher focused on conducting studies within learning health systems to improve outcomes among survivors of ARF and other critical illnesses.

项目概要/摘要每年有超过 100 万美国人需要机械通气，死亡率估计为 30-35% 最近发现，医生的情况在患者、医院和地区层面存在显着差异。与机械通气患者的死亡率相关，增加了另一个水平的变异。研究个别医生的行为会导致结果的这种差异，以及提供者是否会这样做迄今为止，可以通过修改模式来改善结果。尽管有这些干预措施，但仍涉及通气策略和减少伤害疗法。基于证据和指南支持，它们的使用仍然存在很大差异。提供者层面的死亡率差异和基于证据的实践中人口层面的差异代表了具体来说，需要了解医生如何遵守证据。基于的实践各不相同，造成伤害的程度以及改变实践的障碍是什么候选人之前的工作开发了一种方法，使用电子健康记录元数据来分配一个模式。使用这些数据，提供者可以在每个重症监护日向每位患者提供可靠的回顾性信息。 12 家医院对低潮气量通气策略的遵守程度存在显着差异该职业发展奖以这项工作为基础，旨在实现三个目标，即：将促进候选人制定和测试策略的长期目标，以提高对具体来说，在该奖项中，基于证据的护理和改善急性呼吸衰竭幸存者的结果。候选人寻求（1）量化医生在遵守循证实践方面的差异，（2）产生关于循证实践依从性的障碍和促进因素的假设，以及 (3) 制定和试点一项针对循证护理障碍的干预措施为了实现这些目标，候选人将。进行一项回顾性队列研究（目标 1），进行一项纳入 40 个病房的混合方法研究护理机械通气患者的医生（目标 2），并使用干预映射框架开发并试点针对低潮气量通气障碍的干预措施。在使用不同方法完成这三项研究时将获得仔细的补充由来自多个学科的高级研究人员精心挑选的教学课程和结构化指导。这项工作将获得试点拨款和 R01，以支持完成这项干预措施的随机临床试验。研究将建立在候选人过去的培训基础上，并为他提供受保护的时间和实现成为领先的、独立资助的成果研究员的职业目标的经验专注于在学习卫生系统内开展研究，以改善 ARF 幸存者的治疗结果以及其他重大疾病。