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Patient Oriented Research and Mentoring in Critical Care Implementation Science

PI: Jeremy Kahn, MD, MS

Funding: K24HL133444 NIH/NHLBI (8/1/2016 to 7/31/2021)

The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Jeremy Kahn to mentor students, post-doctoral fellows, and junior faculty in critical care organizational science with a focus on implementation of evidence-based practice for patients receiving mechanical ventilation. Efficient translation of evidence into practice is an enduring problem in critical care, with many patients not receiving therapies proven to save lives, particularly complex therapies that require the coordinated efforts of an interprofessional care team. Solving this problem will require scientists with rigorous training in clinical epidemiology, organizational behavior, and implementation science. Dr. Kahn is extremely well positioned to provide mentoring in these areas. He is a midcareer investigator with expertise in the relationship between critical care organization and outcomes, and he has an extensive track record of successful mentoring in patient-oriented research. In this award, he will further his career by participating in targeted activities designed to expand his mentorship skills, increase his knowledge base in organizational science, and strengthen his use of the electronic health record as a tool for implementation research. The scientific goal of this proposal is to identify the the organizational factors associated with effective use of complex care practices for patients receiving invasive mechanical ventilation for acute respiratory failure, including daily spontaneous breathing trials and lung-protective ventilation. We will take a systems science approach which acknowledges that evidence-based practices in critical care require not only good decisions on the part of individual providers but also positive learning behaviors within a dynamic, interprofessional care team. First, we will use organizational surveys of intensive care unit (ICU) providers in the 32 ICU UPMC health system linked to patient-level clinical data to quantitatively assess the relationship between team beliefs, team behaviors and the use of evidence-based practice. Second, we will use ethnography and interviews to qualitatively examine the potential mechanisms and relative importance of these relationships with an eye toward developing novel interventions that improve implementation by targeting organizational behavior. Together, these scientific aims and career development activities will create an ideal laboratory for the training of patient-oriented researchers with skills in critical care implementation science, leading to improved outcomes for patients with severe acute respiratory failure.

Public Health Relevance Statement: Over 700,000 Americans receive invasive mechanical ventilation in an ICU each year. Many of these patients do not receive evidence-based therapies proven to save lives, leading to preventable morbidity and mortality. Innovative strategies to overcome the barriers to evidence-based practice and speed knowledge translation in the ICU are urgently needed. This award will provide the primary investigator with the necessary structure, resources, and protected time to train scientists in patient- oriented research with a focus on knowledge translation in acute respiratory failure, helping new treatments reach the bedside more quickly and leading to improved outcomes for critically ill patients.