Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program

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Brief Title

Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program

Official Title

Evaluation of Implementation of a National Point-of-Care Ultrasound Training Program

Brief Summary

      This VA QUERI Partnered Evaluation Initiative will evaluate the impact of an immersive
      Point-of-care Ultrasound (POCUS) Training Course on provider skill acquisition and retention;
      the frequency of POCUS use by trained providers; and the barriers/facilitators to POCUS in
      the VHA. Data sources include pre- and post-course assessment tools, medical coding data, and
      course evaluations. Providers that participate in the POCUS Training Course will be compared
      to control providers from wait-listed facilities. Additionally, participating facilities vs.
      wait-listed facilities for the POCUS Training Course will be compared. Findings from this
      project will guide ongoing efforts of the investigators' operating partners, VA Specialty
      Care Centers of Innovation (SCCI) and the VA Simulation Learning and Research Network
      (SimLEARN), to develop a national POCUS training program and facilitate implementation of
      POCUS use system-wide in the VA healthcare system.
    

Detailed Description

      Background: Point-of-care ultrasonography (POCUS) has been shown to reduce procedure-related
      complications from invasive bedside procedures, reduce time to diagnosis, and reduce
      ancillary testing, which ultimately reduces patient radiation exposure and healthcare costs.
      Despite its potential advantages, POCUS has not been universally adopted in healthcare due to
      limited numbers of providers trained in use of POCUS. The VA's Simulation Learning, Education
      and Research Network (SimLEARN) and Specialty Care Centers of Innovation (SCCI) have launched
      a collaborative initiative to develop a national POCUS training program. The goal of this
      collaborative training program is to teach VA providers basic diagnostic and procedural
      applications of POCUS. The proposed project will evaluate the effectiveness of an immersive
      POCUS training course developed by SimLEARN on provider skill acquisition and retention,
      frequency of use, and identify barriers/facilitators to POCUS use at participating VHA
      facilities.

      Methods: Approximately 120 participants from a convenience sample of 20 diverse VA facilities
      will participate in a 2.5-day immersive POCUS training course at the SimLEARN National
      Simulation Center in Orlando during fiscal year 2017. The investigators' evaluation plan will
      collect data from facility Chiefs of Staff, providers from facilities participating in POCUS
      training, and providers from wait-listed facilities at different time points using different
      assessment tools: VA Facility POCUS Survey, Provider POCUS Survey, Brief Provider POCUS
      Survey, Pre-/Post-course Knowledge and Skills Test, and Coding Data.

      Objective 1: Evaluate provider skill acquisition and retention, and frequency of POCUS use
      after participation in the POCUS Training Course. Pre- and post-course testing will be used
      to assess acquisition of knowledge and technical skills to perform POCUS exams. Post-course
      testing for knowledge and skill retention, and frequency of use, will be performed 6-9 months
      after the training course.

      Objective 2: Determine the effect of the POCUS Training Course and implementation
      facilitation on facility-level frequency of POCUS use. Facilities with providers that
      infrequently use POCUS will be eligible to participate in the POCUS Training Course. However,
      not all facilities will be able to be accommodated in the 1st year of the training program,
      requiring a facility waiting list. Facilities with providers participating in the POCUS
      Training Course will be compared to wait-listed facilities with regard to frequency of POCUS
      use. Using the Brief Provider POCUS Survey, frequency of POCUS use by providers in both
      participating and waitlisted facilities will be compared. Additionally, coding data will be
      reviewed to assess frequency of procedures performed with and without imaging guidance and
      procedural complication rates comparing the two groups of facilities.

      Objective 3: Determine provider and facility-level barriers and facilitators to POCUS use.
      Provider and facility-level barriers will be assessed using 3 tools: Provider POCUS Survey
      (trained providers), Brief Provider POCUS Survey (wait-listed and participating facilities),
      and Facility POCUS Survey (all facilities). Differences in barriers reported and their
      relationship to frequency of POCUS use will be compared.

      Objective 4: Development of POCUS Champions course to facilitate local implementation by
      addressing facility-level barriers. The POCUS Champions course will address several
      facility-level barriers to implementation that have been identified by the PEI: lack of image
      archiving, limited access to ultrasound machines, undefined credentialing/privileging
      processes, need for a quality assurance process, and lack of trained providers. The POCUS
      Champions course will include an annual 3-day boot camp, bi-monthly conference calls, and
      ongoing mentorship. The goal of the 3-day boot camp will be for Champions to prepare a local
      implementation plan that can be presented to their facility's leadership. During the
      bimonthly conference calls, a brief didactic on a focused topic will be presented followed by
      an update on local progress from each site. The initial goal of the POCUS Champions course is
      to facilitate implementation of POCUS use in VA facilities, starting with 4-6 facilities that
      can serve as models for other facilities. The research to date has identified these elements
      as core components of a successful POCUS program. The POCUS Champions course will support
      progress on intermediate milestones towards ensuring these core components are in place, to
      facilitate adoption, reach, and sustainment. This provides a roadmap to sustainable POCUS
      use.

      Deliverables: The primary deliverable will be report that will summarize the effect of
      training on provider skill acquisition and retention, frequency of use of POCUS, and barriers
      and facilitators to POCUS implementation. This project will guide SimLEARN's and SCCI's
      efforts to develop a National POCUS Training Program and implement POCUS use nationally in
      the VA healthcare system. Additionally, this report may serve as a roadmap for the VHA for
      implementation of similar simulation-based educational innovations.
    


Study Type

Observational


Primary Outcome

Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months

Secondary Outcome

 Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months

Condition

Other Acute Illnesses Presenting to the Hospital


Study Arms / Comparison Groups

 Early Intervention
Description:  This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information



Estimated Enrollment

116

Start Date

October 3, 2016

Completion Date

September 30, 2020

Primary Completion Date

June 29, 2018

Eligibility Criteria

        Inclusion Criteria:

        Selection of VA facilities invited to participate in the national POCUS training course was
        based on data from a national needs assessment conducted by the VA's Health Analysis and
        Information Group. VA facilities that meet all of the following inclusion criteria are
        eligible to send physicians to participate in the POCUS training course:

          1. Chief of staff desires POCUS training for his/her facility

          2. >=2 Service Chiefs from emergency medicine, critical care medicine, or hospital
             medicine desire training for his/her physicians, AND

          3. >=1 portable ultrasound machine(s) available to physicians within these services

        Exclusion Criteria:

          1. Chief of staff does not desire POCUS training for his/her facility

          2. <2 Service Chiefs from emergency medicine, critical care medicine, or hospital
             medicine desire training for his/her physicians, OR

          3. No portable ultrasound machine(s) available to physicians within these services
      

Gender

All

Ages

N/A - N/A

Accepts Healthy Volunteers

Accepts Healthy Volunteers

Contacts

Nilam J Soni, MD MSc, , 

Location Countries

United States

Location Countries

United States

Administrative Informations


NCT ID

NCT03296280

Organization ID

PEX 16-003

Secondary IDs

I50HX002263-01A1

Responsible Party

Sponsor

Study Sponsor

VA Office of Research and Development

Collaborators

 US Department of Veterans Affairs

Study Sponsor

Nilam J Soni, MD MSc, Principal Investigator, South Texas Health Care System, San Antonio, TX


Verification Date

March 2020