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