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A Mixed Methods Evaluation of the Implementation of Prone Positioning in COVID-19 ARDS

Award Number: F32HL160039
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS
PERIOD OF PERFORMANCE START DATE: 09/03/2021
PERIOD OF PERFORMANCE END DATE: 06/30/2023

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A Mixed Methods Evaluation of the Implementation of Prone Positioning in COVID-19 ARDS - Project Summary/Abstract Despite decades of research, mortality from the acute respiratory distress syndrome (ARDS) remains high. Recently, ARDS has received increased attention during the coronavirus disease 19 (COVID-19) pandemic, as the majority of patients with COVID-19 requiring intensive care unit (ICU) admission develop ARDS. The resulting increases in patients with this syndrome has highlighted the need to ensure broad and sustained implementation of existing evidence-based interventions (EBIs) for ARDS. One such lifesaving ARDS intervention is prone positioning. While prone position is supported by randomized controlled trials and recommended in ARDS guidelines, historically it has been underutilized. As healthcare delivery has changed rapidly and dramatically during COVID-19, the critical care practice of prone positioning has also evolved. Prior to the pandemic, prone positioning was utilized in 10-15% of appropriate patients, and now during the pandemic is being used in 40-80% of patients depending on the setting. Understanding the mechanisms behind this rapid practice change is key to more broadly implementing prone positioning and other EBIs for ARDS care during the COVID-19 pandemic and beyond. The main objective of this project is to evaluate the factors influencing the increased use of prone positioning during COVID-19. We hypothesize that factors related to organizational changes (e.g., proning teams, proning protocols and staffing levels), provider characteristics (e.g., belief in efficacy, recognition of ARDS) and patient factors (e.g., higher disease severity) led to the marked increases in use of prone positioning during the COVID-19 pandemic. We will use implementation science tools including the Consolidated Framework for Implementation Research (CFIR) to provide a comprehensive mixed methods evaluation of prone positioning during the pandemic. Using a retrospective cohort study of mechanically ventilated patients with COVID-19 ARDS, we will define the frequency of prone positioning in different settings within our health system and evaluate the patient and ICU factors that predict proning use. Using qualitative methods, we will conduct semi- structured interviews with ICU team members to explore the facilitators of and barriers to prone positioning in COVID-19. Finally, we will survey ICU team members across our health system to evaluate the CFIR implementation determinants associated with the implementation outcomes of acceptability, appropriateness, fidelity and sustainability of prone positioning. This work has the potential to inform a broader and sustained implementation of prone positioning as well as increase our understanding of how to rapidly translate therapeutic advances to the bedside of critically ill patients. This research will provide the applicant with the necessary training to develop the skills needed to pursue a career as an independently funded researcher working in the field of implementation science and critical care.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = -$17,454 )
2024	2022	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	11/1/2023	NON-COMPETING CONTINUATION	-$16,410
2024	2022	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	2	4/24/2024	NON-COMPETING CONTINUATION	-$1,044
														Subtotal = -$17,454

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	7/31/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $81,250 )
2022	2022	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	8/10/2022	NON-COMPETING CONTINUATION	$81,250
														Subtotal = $81,250

Issue Date FY: 2021 ( Subtotal = $77,586 )
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	1	9/17/2021	NEW	$0
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	002	1	9/20/2021	NEW	$0
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	9/3/2021	NEW	$77,586
														Subtotal = $77,586

Grand Total All Awards = $141,382

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A Mixed Methods Evaluation of the Implementation of Prone Positioning in COVID-19 ARDS

Award Number: F32HL160039

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS

PERIOD OF PERFORMANCE START DATE: 09/03/2021

PERIOD OF PERFORMANCE END DATE: 06/30/2023

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