Promoting Change in Practice for Respiratory Failure: the PRECIPICE Study

PROJECT SUMMARY
Background: Approximately 300,000 Hispanic individuals experience respiratory failure each year in the U.S. Hispanic patients are twice as likely to die from respiratory failure as non-Hispanic patients. There is an urgent need to identify and remediate mechanisms that increase risk of death from respiratory failure. The team’s preliminary work identified two potential mechanisms: Hispanic patients with respiratory failure are more likely to be deeply sedated and less likely to receive physical therapy than non-Hispanic patients, which are both associated with mortality and poor long-term functional outcomes. The overall objective of this proposal is to improve outcomes for patients with respiratory failure through changes in intensive care unit (ICU) practice.
Specific Aims and Project Methods: Aim 1: Evaluate trajectories of long-term functional outcomes for Hispanic and non-Hispanic survivors of respiratory failure. An analysis of a unique registry of patients with respiratory failure will examine risk-adjusted trajectories of six-month mortality and functional outcomes among 96 Hispanic and 96 matched non-Hispanic control patients. Aim 2: Characterize care delivery for respiratory failure. Detailed site visits at ten heterogeneous U.S. hospitals will be integrated with interviews and surveys of ICU clinicians to understand delivery of deep sedation and other care processes that preliminary work demonstrate to be differentially applied by ethnicity. Aim 3: Refine and pilot an intervention to promote guideline-concordant care. The team’s preliminary intervention will be iteratively refined through patient, family, and clinician engagement and piloted at two U.S. ICUs.
Unique Aspects of this Proposal: This proposal tackles an enduring problem in critical care—detecting, understanding, and eliminating disparities—by uniting a sociologist with expertise in disparities research and intervention design with a critical care physician with expertise in health services research. With an experienced team of co-investigators, preeminent National Advisory Board, and rigorous mixed-methods design, the PIs are uniquely equipped to address this pressing challenge.
Anticipated Impact: NHLBI priorities call for robust evidence and innovations in intervention design to improve respiratory health. The outcome of this study will be a characterization of care delivery contributing to worse outcomes among Hispanic patients with respiratory failure and an intervention aimed at reducing mortality from respiratory failure.

Grant Number: 5R01HL157361-04
NIH Institute/Center: NIH
Principal Investigator: Mari Armstrong-Hough