Abstract

Weproposetotesttheimplementationofevidence-basedpreventiveinterventionsthroughaVirtualLearning Collaborative(VLC)withandwithoutthenoveluseAutomatedSurveillanceReporting(ASR)interventionto changeclinicalpracticeandimprovepatientsafetyincommondiagnosticprocedures.Over2millionpeoplein theUnitedStatesundergodiagnosticorinterventionalcardiaccatheterizationeachyear.Acutekidneyinjury (AKI),apatientsafetymetricsetbytheNationalQualityForum,occursinupto14%ofallpatientsfollowinga procedureandupto50%inpatientswithpre-existingchronickidneydisease(CKD),makingAKIthemost prevalentadverseevent.PatientsdevelopingAKIhaveanincreasedriskofseriousadverseevents.Thereare widelyacceptedinterventionstopreventAKIinpatientsundergoingcardiaccatheterization.Ourresearchteam hasdemonstratedAKIcanbepreventedin28%ofpatientswithCKDthroughalargeregionalpilot.Ourteam hasalreadydevelopedASRtechniquesforAKInationallywithintheVeterans?Administration.Basedonour ownpreliminarystudies,wehypothesizetheincorporationofanautomatedplug-inASRtoolkittoprovidenear- realtimefeedbacktofront-linecareteamswillsignificantlyaugmentbothVLCandTechnicalAssistance(TA) interventionsinimplementationtrials.Ourobjectiveistoconductanationalrandomizedclinicaltrialtestingthe useofVLCorTAwithorwithoutaplug-inASRtoolkittodetermineifASRsignificantlyimprovesoutcomesfor patientsundergoingprocedureswithcontrastdyetoovercometheinconsistentapplicationofknownwaysto preventAKI.TherationaleunderlyingtheprojectisthatASRcouldprovetobeaplug-invehicletoimprove patientendpointsinevidence-basedpreventiveinterventionsincommondiagnosticprocedures.Weplanto testourhypothesisthroughthefollowingspecificaimsina2x2factorialcluster-randomizedtrial.Forallaims, 16hospitalswillberandomizedtoreceiveoneofthefollowinginterventionsfor18-months:A)Technical Assistance(TA);?B)TechnicalAssistancewithAutomatedSurveillanceReporting(TA+ASR);?C)Virtual LearningCollaborative(VLC)withteam-basedcoaching(VLC);?andD)VirtualLearningCollaborativewith AutomatedSurveillanceReporting(VLC+ASR).
SpecificAim1 :ComparetheefficacyofaVLCand/orASR comparedtoTAtoreducetheincidenceofAKI.
SpecificAim2 :EvaluatethesustainedefficacyofVLCand/or ASRtoreducetheincidenceofAKIfollowingtheinterventionperiod.Theinterventionsproposedusenovel interactivevideocoachingsessionsandASRaslow-costscalableimplementationstrategiestopreventa clinicalendpoint(AKI).Eighteenhospitalshaveagreedtoparticipateandberandomized.Weexpectthe impactofaplug-inASRtoaugmentevidencebasedpreventiveinterventionsandVLCcouldsignificantly improvetheconsistentapplicationoftheseinterventionsandimplementationtrials.Inouropinion,ourstudy willopenthedoortoanewparadigmofimplementationscienceseekingtocontinuouslyimprovehealthcare.

Public Health Relevance

Whenapersonhasanimagingprocedurethatusesradio-contrastdye,thereisapossibilityofdamagetothat person?skidneys,whichcouldresultinbeingondialysisorearlydeath.Wearetestingnovelcoachingand automatedtoolstohelphealthcareteamsapplyapproachesthathavebeenshowntopreventdamageto kidneysduringacardiaccatheterizationprocedure.Theresultsofourstudywillhelpinformhealthcareleaders onhowtoimplementlow-costpreventivestrategiesthroughteam-basedcoachingandsurveillancereporting forkidneyinjuryandotherpatientsafetyprioritiestoeveryhospitalintheUnitedStates.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK113201-02
Application #
9742466
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Schulman, Ivonne Hernandez
Project Start
2018-07-15
Project End
2023-05-31
Budget Start
2019-06-01
Budget End
2020-05-31
Support Year
2
Fiscal Year
2019
Total Cost
Indirect Cost

  Institution

Name
Dartmouth College
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755