Putting implementation into context to advance the management of mechanically ventilated patients

Active Project Grant Awarded Last action

Award ID
R01HL180743
Recipient
Awarding agency
Obligated
$1,437,334

Award facts

Assistance listing
93.837 Cardiovascular Diseases Research
Completion date 32% complete
Place of performance
Philadelphia, PA 19104, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Over one million americans undergo invasive mechanical ventilation (IMV) annually in intensive care units (ICUS). A few interventions have improved patient-centered outcomes in IMV patients, including sedation minimization, corticosteroid administration in selected patients, and low tidal volume ventilation and prone positioning in the subgroup patients with acute respiratory distress syndrome (ARDS). However, variability exists across ICUS in processes of care, clinical outcomes, and resource utilization. ICUS are highly complex interprofessional environments, and knowledge gaps remain regarding how contextual elements influence implementation determinants in different ICUS. The coronavirus disease 2019 (COVID-19) pandemic created unprecedented surges of patients requiring IMV and catalyzed rapid and dynamic changes in critical care delivery, facilitating some evidence-based practices after many years of persistently low penetration, and impeding others. Furthermore, new evidence, such as corticosteroids for COVID-19 and pneumonia, may have later influenced practice changes for IMV patients more broadly. Thus, this major disruption in critical care delivery is a unique opportunity to gain new knowledge about implementation in the ICU context. The overall objective of this proposal is to better understand the interplay between contextual factors and intervention features in care delivery for IMV patients. Guided by implementation frameworks, we will employ state-of-the-art causal inference methods and innovative qualitative approaches to conduct three specific aims: (1) quantify penetration of four evidence-based treatments - sedation minimization, corticosteroid administration, low tidal volume ventilation, and prone positioning - over time among IMV patients and specific subgroups; (2) develop a novel conceptual model of ICU implementation incorporating relationships between determinants and contextual elements; and (3) apply implementation mapping to create adaptable menus to facilitate evidence-based practices. We will apply state-of-the-art causal inference methods to analyze a diverse, multicenter retrospective cohort of IMV patients admitted to more than 30 ICUS in 16 hospitals before, during, and after the height of the COVID-19 pandemic. In addition, we will use cutting-edge qualitative techniques and implementation research frameworks and will engage an array of stakeholders to develop implementation menus for each treatment that not only provide strategies to promote utilization of evidence- based treatments but also guidance for tailoring those strategies to different contexts. This project will advance the science of care delivery in a high-stakes setting by increasing the evidence regarding how contextual elements interact with treatment characteristics in critical care delivery. IT will generate direct preliminary data for future implementation studies to test strategies to promote evidence-based care of IMV patients. Finally, IT will create a conceptual model with potential application to delivery of critical care interventions in different ICU contexts more broadly.

Transactions

Action Obligated Date
Amendment $688,364
Original award $748,970

Subawards

Subrecipient Amount Awarded
Pennsylvania State University The PSU team will be integrally involved in the development of the study design, data collection and analyses, and interpretation of study results and… $102,949
The Johns Hopkins University "Johns Hopkins University (JHU) team: JHU co-investigators will be integrally involved in the development of the study design, data collection and analyses, and… $190,207
Colquitt Regional Medical, Inc. "Colquitt Regional Medical Center (CRMC) team: The CRMC team will be responsible for the data extraction and transfer for patients admitted to the CRMC ICU,… $41,164
The Johns Hopkins University "Johns Hopkins University (JHU) team: JHU co-investigators will be integrally involved in the development of the study design, data collection and analyses, and… $192,985
Pennsylvania State University The PSU team will be integrally involved in the development of the study design, data collection and analyses, and interpretation of study results and… $110,773

Quick answers

Who received award R01HL180743?

R01HL180743 was awarded to The Trustees Of The University Of Pennsylvania by National Heart Lung and Blood Institute (National Institutes of Health) on August 15, 2025.

How much is award R01HL180743 worth?

$1,437,334 has been obligated on R01HL180743.

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