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Implementation of Coordinated Spontaneous Awakening and Breathing Trials Using Telehealth-Enabled, Real-Time Audit and Feedback for Clinician AdHerence: A Type II Hybrid Effectiveness-Implementation

Award Number: U01HL159878
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: COOPERATIVE AGREEMENT
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY Although invasive mechanical ventilation (IMV) is a lifesaving treatment for about 300,000 U.S. patients with acute respiratory failure each year, it is associated with significant risks. Spontaneous awakening and breathing trials during IMV improve patient outcomes. Coordination of spontaneous awakening and breathing trials (C-SAT/SBT) is complex and significant barriers to implementation exist and adherence with C-SAT/SBT across institutions is highly variable. Although national guidelines recommend daily coordinated C-SAT/SBT in IMV patients they are underused. Telehealth-enabled remote care is positioned to improve C-SAT/SBT use. At Intermountain Healthcare, we have system-wide tele-critical care services staffed by critical care physicians, nurses, and respiratory therapists who remotely monitor and assist with patients in ICUs using real-time audiovisual communication, a systemwide electronic medical record (EMR), electronic dashboards, and clinical decision support. We recently studied the impact of implementation strategies to improve evidence-based practices for lung protective ventilation (LPV) in 3 pilot ICUs, and then adopted a Telehealth-Enabled, real-time Audit and feedback for Clinician adHerence (“TEACH”) to disseminate LPV adherence strategies to the other 14 ICUs, achieving over 90% adherence (NCT 03984175). This successful approach could help identify candidates for C-SAT/SBT protocols, prompt bedside providers to perform C-SAT/SBT, and guide execution. The specific aims of this research are to (1) adapt baseline implementation strategies and to target C- SAST/SBT using the Consolidated Framework for Implementation Research; (2) conduct a type II cluster- randomized hybrid effectiveness-implementation trial to compare a usual audit and feedback implementation approach to a usual audit and feedback implementation approach augmented with a Telehealth-Enabled, real- time Audit and feedback for Clinician adHerence (“TEACH”) to promote C-SAT/SBT; and (3) evaluate sustained adherence to the TEACH enhancement in the final year after the RCT has ended. Completion of this project will advance knowledge regarding the effective and sustainable strategies for C- SAT/SBT implementation specifically and the effectiveness generally of telehealth remote monitoring and prompting strategies to aid best practice implementation in ICUs. The proposed research builds on the study team’s existing work and has potential to develop more informed and effective care of persons with respiratory failure. Spread and scale of this telehealth-enabled, central monitoring of critical aspects of care for ICU patients is particularly important to study now, given the vulnerability of ICU staff to COVID-19 exposure.


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 = $1,014,255 )
2023	2023	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Lung Diseases Research	000	3	8/18/2023	NON-COMPETING CONTINUATION	$1,014,255
														Subtotal = $1,014,255

Issue Date FY: 2022 ( Subtotal = $1,029,882 )
2022	2022	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Lung Diseases Research	000	2	8/31/2022	NON-COMPETING CONTINUATION	$1,029,882
														Subtotal = $1,029,882

Issue Date FY: 2021 ( Subtotal = $619,678 )
2021	2021	INTERMOUNTAIN HEALTH CARE, INC.	36 S STATE ST STE 1600	SALT LAKE CITY	UT	84111	SALT LAKE	USA	Lung Diseases Research	000	1	9/1/2021	NEW	$619,678
														Subtotal = $619,678

Grand Total All Awards = $2,663,815

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Implementation of Coordinated Spontaneous Awakening and Breathing Trials Using Telehealth-Enabled, Real-Time Audit and Feedback for Clinician AdHerence: A Type II Hybrid Effectiveness-Implementation

Award Number: U01HL159878

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: COOPERATIVE AGREEMENT

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

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