Disparities Report Card Disparities Council September 27, 2010.
NIH Challenge Grant from the National Institute of Healths Center for Minority Health and...
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![Page 1: NIH Challenge Grant from the National Institute of Healths Center for Minority Health and Disparities Critical Care Excellence in Sepsis and Trauma - CREST.](https://reader035.fdocuments.us/reader035/viewer/2022070306/5517670a5503463e368b4929/html5/thumbnails/1.jpg)
NIH Challenge Grant from the National Institute of Health’s Center for Minority Health and
Disparities
Critical Care Excellence in Critical Care Excellence in Sepsis and Trauma - CRESTSepsis and Trauma - CREST
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CREST PersonnelCREST PersonnelPrincipal Investigators:
◦ Dee W. Ford, MD, MSCR◦ Samir M. Fakhry, MD
Co-investigators: ◦ Jane Zapka, ScD◦ Kit Simpson, PhD◦ Anbesaw Selassie, DrPh
Program Coordinator◦ Laura Langston
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CREST RationaleCREST Rationale
Intensivists improve outcomesThere is a national shortage of
intensivistsSmall, rural communities lack
resources and economies of scaleProprietary, full-service tele-ICU’s
are costly
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CREST RationaleCREST Rationale
Is there a technologic middle-ground to selectively leverage MUSC’s critical care expertise into rural, local hospitals when it is clinically most imperative?
The “golden hours”…
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CRESTCREST
HypothesisA telemedicine program including education and
clinical consultation between a tertiary care academic medical center and rural, local hospitals will significantly improve key treatment decisions and outcome measures in sepsis and trauma.
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CREST Research DesignCREST Research DesignQuasi-experimental pre/post
intervention
Propensity score matched controls
Multivariable regression modeling accounting for clustering
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Hub-and-Spoke ModelHub-and-Spoke Model
MUSC=hub
Hub MD + laptop
Patient in Spoke ED
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CREST Telemedicine CREST Telemedicine PlatformPlatform
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Hospital SelectionHospital SelectionFour sites enrolled
◦Medically underserved counties◦USDA designated rural counties
First site: Orangeburg Regional Medical Center◦Education roll out complete◦Consults beginning soon
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Lessons Learned (so far)Lessons Learned (so far)Institutional
Technological
Research
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Lessons LearnedLessons LearnedInstitutional
◦Low resource hospitals have few resources
◦Everything takes more time than anticipated Arrange 1st visit, MOA, credentialing, etc. Internal procedures
◦Patients are hospitals’ economic basis Concern over loosing patients to larger center
◦Communication is essential Local champion is invaluable
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Lessons LearnedLessons LearnedTechnological
◦There is always something with IT
◦Stipulate in the contract key details Timelines Deliverables Contingency plans
◦Technical dry runs and more dry runs
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Lessons Learned Lessons Learned Research
◦Different perspectives – research project versus educational and clinical program
◦Federal Wide Assurance (FWA) – you gotta’ have one
◦Training onsite staff is challenging
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CREST Pre-implementation CREST Pre-implementation Research ProductsResearch Products Organizational assessment tools Domains
◦ evidence assessment◦ clinical experience◦ hospital characteristics ◦ program champion◦ culture/climate◦ perceived ease of use◦ usefulness◦ change readiness◦ change efficacy◦ style◦ leadership
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CREST Pre-implementation CREST Pre-implementation Research ProductsResearch ProductsKey informant interviews
◦Orangeburg: n=8◦Bamberg: n=4◦Barnwell: n=6◦Williamsburg: n=5
CME/CE (thus far only at Orangeburg)◦Sepsis CE credit given to: 21◦Sepsis CME credit given to: 14◦Trauma CE credit given to: 23◦Trauma CME credit given to: 11
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SummarySummarySubstantial pre-research effort is
necessary
Distinct from conventional clinical trials
Unique scientific skills required◦Effectiveness versus efficacy