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Implementation of interprofessional training to improve uptake of noninvasive ventilation in patients hospitalized with severe COPD exacerbation

Award Number: R01HL146615
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY COPD is the fourth leading cause of death in the US, and COPD exacerbations result in approximately 700,000 hospitalizations annually. Patients who do not respond to pharmacotherapy are placed on invasive (IMV) or noninvasive mechanical ventilation (NIV). Although IMV reverses hypercapnia/hypoxia, it causes significant morbidity and mortality. NIV is an alternative ventilatory option for acute respiratory failure that provides positive pressure ventilation via a mask. Multiple randomized controlled trials and analyses of real-world data have shown that patients treated with NIV are less likely to require IMV and have better mortality and length of hospital stay. NIV is recommended in all COPD guidelines as the first-line treatment for patients with severe exacerbation who have failed pharmacologic treatment. Yet, despite compelling evidence of benefit, we have previously demonstrated substantial variation in the implementation of NIV across hospitals, leading to preventable morbidity and mortality. Through a series of mixed-methods studies we and other investigators have found that successful implementation of NIV requires physicians, respiratory therapists (RTs), and nurses to communicate and collaborate effectively to select appropriate patients for treatment, and to carefully manage patients after NIV initiation. These studies suggest that efforts to increase the use of NIV in COPD need to account for the complex and interdisciplinary nature of NIV delivery and the need for team coordination. Our main goal is to conduct a two-arm pragmatic type III hybrid implementation- effectiveness trial to compare two educational strategies in 20 hospitals with low NIV use in COPD: interprofessional education (IPE) which targets complex team-based care in NIV delivery and on-line education (OLE). The primary outcome of the trial is change in the hospital rate of NIV use among patients with COPD requiring ventilatory support. Our central hypothesis is that IPE will outperform OLE, leading to greater improvement in the uptake of NIV and that RT autonomy and team functionality will act as mediators. We will accomplish our goal by completing three specific aims. In Aim 1 we will compare the uptake change over time of NIV use among patients with COPD in hospitals enrolled in the two arms. In Aim 2, we will explore mediators' role (RT autonomy and team functionality) on the relationship between the implementation strategies and implementation effectiveness. Finally, in Aim 3, through interviews with providers, we will assess acceptability and feasibility of the educational training. This proposal is significant because NIV is the only therapy that has been shown to improve short-term survival for patients hospitalized for exacerbation of COPD, yet a large number of hospitals still have not adopted this approach fully. This proposal is feasible because it builds upon our strong interdisciplinary team's experience and it will be conducted within a large network of hospitals that we have previously worked with, and because it will have a very pragmatic design. Our application is innovative because it will be among the first to carefully test the impact of IPE in the inpatient setting. This work promises to change practice by offering approaches to facilitate greater uptake of NIV and may generalize to other interventions directed to seriously-ill patients.


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: 2023 ( Subtotal = -$7,668 )
2023	2021	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Lung Diseases Research	000	3	5/15/2023	NON-COMPETING CONTINUATION	-$7,668
														Subtotal = -$7,668

Issue Date FY: 2022 ( Subtotal = -$431,339 )
2022	2021	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Lung Diseases Research	001	3	8/12/2022	NON-COMPETING CONTINUATION	-$7,018
2022	2021	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT ST	SPRINGFIELD	MA	01199	HAMPDEN	USA	Lung Diseases Research	000	3	1/10/2022	NON-COMPETING CONTINUATION	-$424,321
														Subtotal = -$431,339

Issue Date FY: 2021 ( Subtotal = $632,562 )
2021	2021	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT ST	SPRINGFIELD	MA	01199	HAMPDEN	USA	Lung Diseases Research	000	3	4/23/2021	NON-COMPETING CONTINUATION	$632,562
														Subtotal = $632,562

Issue Date FY: 2020 ( Subtotal = $696,942 )
2020	2020	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT ST	SPRINGFIELD	MA	01199	HAMPDEN	USA	Lung Diseases Research	001	2	7/15/2020	NON-COMPETING CONTINUATION	$0
2020	2020	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT ST	SPRINGFIELD	MA	01199	HAMPDEN	USA	Lung Diseases Research	000	2	4/3/2020	NON-COMPETING CONTINUATION	$696,942
														Subtotal = $696,942

Issue Date FY: 2019 ( Subtotal = $627,622 )
2019	2019	BAYSTATE HEALTH SYSTEM HEALTH SERVICES, INC.	759 CHESTNUT ST	SPRINGFIELD	MA	01199	HAMPDEN	USA	Cardiovascular Diseases Research	001	1	8/14/2019	NEW	$0
2019	2019	PIONEER VALLEY LIFE SCIENCES INSTITUTE OF BAYSTATE MEDICAL CENTER AND UMASS AMHERST, INC.	3601 MAIN ST	SPRINGFIELD	MA	01199	HAMPDEN	USA	Cardiovascular Diseases Research	000	1	5/9/2019	NEW	$627,622
														Subtotal = $627,622

Grand Total All Awards = $1,518,119

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Implementation of interprofessional training to improve uptake of noninvasive ventilation in patients hospitalized with severe COPD exacerbation

Award Number: R01HL146615

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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