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| ID | Type | Description | Link |
|---|---|---|---|
| I50HX002263-01A1 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| US Department of Veterans Affairs | FED |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Early Intervention | This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17 | ||
| Late Intervention | This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17. |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months | Provider self-reported data pre- and post-intervention on frequency of point-of-care ultrasound use, based on number of exams per week. | Baseline compared to 6-9 months later. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months | Provider knowledge will be tested pre- and post-intervention (at baseline [pre-course] and 6-9 months post-course). Knowledge Exam has a minimum of 0 points and a maximum of 30 points (1 pt per question). A higher score indicates more knowledge about POCUS. A positive change in score means a better outcome post-course (net increase in knowledge) compared to baseline. |
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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:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nilam Jayant Soni, MD MSc | South Texas Health Care System, San Antonio, TX | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| South Texas Health Care System, San Antonio, TX | San Antonio | Texas | 78229 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38581600 | Derived | Iqbal A, Ahmad M, Murray KJ, Sim J, Lund TJS, Andrade AJ, Perez-Sanchez A, Mader MJ, Haro EK, Williams JP, Nathanson R, Soni NJ. Current Use and Barriers to Point-of-Care Ultrasound in Rheumatology: A National Survey of VA Medical Centers. Rheumatol Ther. 2024 Jun;11(3):855-867. doi: 10.1007/s40744-024-00665-2. Epub 2024 Apr 6. | |
| 30878406 | Derived | Boyd JS, LoPresti CM, Core M, Schott C, Mader MJ, Lucas BP, Haro EK, Finley EP, Restrepo MI, Kessler C, Colon-Molero A, Pugh J, Soni NJ. Current use and training needs of point-of-care ultrasound in emergency departments: A national survey of VA hospitals. Am J Emerg Med. 2019 Sep;37(9):1794-1797. doi: 10.1016/j.ajem.2019.02.043. Epub 2019 Feb 28. No abstract available. |
| Label | URL |
|---|---|
| VA Quality Enhancemen Research Initiative (QUERI) | View source |
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10 facilities were to participate in the first 6 POCUS course session during FY17. 10 facilities were to participate in the last 6 POCUS course sessions during FY17. Participants, rather than facilities, were recruited and assigned to to the early or late intervention arms.
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| ID | Title | Description |
|---|---|---|
| FG000 | Early Intervention | This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17. Although facilities are being recruited the intervention is taking place at the individual level. All reporting will be at the individual level. |
| FG001 |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Sep 9, 2016 |
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| Baseline compared to 6-9 months later. |
| Change in Point-of-care Ultrasound Cardiac Skills From Baseline to 6-9 Months | Provider hands-on cardiac skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Cardiac Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Baseline compared to 6-9 months later. |
| Change in Point-of-care Ultrasound Lung Skills From Baseline to 6-9 Months | Provider hands-on lung skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Lung Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Baseline compared to 6-9 months later. |
| Change in Point-of-care Ultrasound Peripheral IV Skills From Baseline to 6-9 Months | Provider hands-on peripheral IV skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Peripheral IV Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Baseline compared to 6-9 months later. |
| Change in Point-of-care Ultrasound Abdominal Skills From Baseline to 6-9 Months | Provider hands-on abdominal skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Abdominal Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Baseline compared to 6-9 months later. |
| Change in Barrier to Point-of-care Ultrasound Use (Ability to Operate) From Baseline to 6-9 Months Post-Course | Change in percentage of providers who reported not knowing how to operate POCUS 6-9 months post-course compared to pre-course. A positive percentage indicates a better outcome post-course. | Baseline compared to 6-9 months later. |
| Change in Barriers to Point-of-care Ultrasound Use (Skill Maintenance) From Baseline to 6-9 Months Post-Course | Change in percentage of providers who reported experiencing difficulty with maintaining POCUS skills pre-course compared to 6-9 months post-course. A positive percentage indicates more providers are experiencing this barrier post-course, which is not unexpected as more providers acquire POCUS skills. | Baseline compared to 6-9 months later. |
| Late Intervention |
This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17. Although facilities are being recruited the intervention is taking place at the individual level. All reporting will be at the individual level. |
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| ID | Title | Description |
|---|---|---|
| BG000 | Early Intervention | This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17 |
| BG001 | Late Intervention | This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17. |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
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| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Row populations differs from Overall because age was self-reported through an online survey and was not answered by all participants. | Mean | Standard Deviation | years |
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| Sex: Female, Male | Row populations differs from Overall because sex was self-reported through an online survey and was not answered by all participants. | Count of Participants | Participants |
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| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
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| Provider Specialty | Row populations differs from Overall because provider specialty was self-reported through an online survey and was not answered by all participants. | Number | participants |
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| Facility Location | Number | participants |
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| Years of practice since residency | Row populations differs from Overall because years since residency was self-reported through an online survey and was not answered by all participants. | Mean | Standard Deviation | years |
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| Percent of time performing direct patient care | Row populations differs from Overall because percent of time performing direct patient care was self-reported through an online survey and was not answered by all participants. | Mean | Standard Deviation | % of time performing direct pt care |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in Frequency of Point-of-care Ultrasound Use for Diagnostic and Procedural Applications at Baseline and 6-9 Months | Provider self-reported data pre- and post-intervention on frequency of point-of-care ultrasound use, based on number of exams per week. | Participants who completed a provider survey both at the start and about 6-9 months later | Posted | Mean | 95% Confidence Interval | Number of POCUS Exams/week | Baseline compared to 6-9 months later. |
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| Secondary | Change in Point-of-care Ultrasound Knowledge From Baseline to 6-9 Months | Provider knowledge will be tested pre- and post-intervention (at baseline [pre-course] and 6-9 months post-course). Knowledge Exam has a minimum of 0 points and a maximum of 30 points (1 pt per question). A higher score indicates more knowledge about POCUS. A positive change in score means a better outcome post-course (net increase in knowledge) compared to baseline. | Participants who completed a knowledge survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts. | Posted | Mean | 95% Confidence Interval | change in score on POCUS Knowledge scale | Baseline compared to 6-9 months later. |
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| Secondary | Change in Point-of-care Ultrasound Cardiac Skills From Baseline to 6-9 Months | Provider hands-on cardiac skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Cardiac Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts. | Posted | Mean | 95% Confidence Interval | change in score on Cardiac Skills scale | Baseline compared to 6-9 months later. |
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| Secondary | Change in Point-of-care Ultrasound Lung Skills From Baseline to 6-9 Months | Provider hands-on lung skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Lung Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts. | Posted | Mean | 95% Confidence Interval | change in score on Lung Skills scale | Baseline compared to 6-9 months later. |
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| Secondary | Change in Point-of-care Ultrasound Peripheral IV Skills From Baseline to 6-9 Months | Provider hands-on peripheral IV skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Peripheral IV Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts. | Posted | Mean | 95% Confidence Interval | change in score on Peri-IV Skills scale | Baseline compared to 6-9 months later. |
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| Secondary | Change in Point-of-care Ultrasound Abdominal Skills From Baseline to 6-9 Months | Provider hands-on abdominal skills will be tested pre- and post-intervention (at baseline [pre-course], and 6-9 months post-course). The minimum score on the POCUS Abdominal Skills scale is 0 points and the maximum is 100 points. A higher score indicates more skill. A positive change in score means a better outcome post-course (net increase in skills) compared to baseline. | Participants who completed a skills survey both at the start and about 6-9 months later were analyzed. Those who did not provide both surveys are not reported. Row populations may therefore differ from total population counts. | Posted | Mean | 95% Confidence Interval | change in score on Abdom Skills scale | Baseline compared to 6-9 months later. |
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| Secondary | Change in Barrier to Point-of-care Ultrasound Use (Ability to Operate) From Baseline to 6-9 Months Post-Course | Change in percentage of providers who reported not knowing how to operate POCUS 6-9 months post-course compared to pre-course. A positive percentage indicates a better outcome post-course. | Participants who reported not knowing how to use POCUS machine in survey at the beginning of the course | Posted | Number | percentage of participants | Baseline compared to 6-9 months later. |
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| Secondary | Change in Barriers to Point-of-care Ultrasound Use (Skill Maintenance) From Baseline to 6-9 Months Post-Course | Change in percentage of providers who reported experiencing difficulty with maintaining POCUS skills pre-course compared to 6-9 months post-course. A positive percentage indicates more providers are experiencing this barrier post-course, which is not unexpected as more providers acquire POCUS skills. | Participants who reported at least one barrier 6-9 months after course | Posted | Number | percentage of participants | Baseline compared to 6-9 months later. |
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Adverse events were not monitored. Not applicable.
Adverse events were not monitored. Not applicable.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Early Intervention | This cohort of 10 facilities will undergo early training by participating in the first 6 POCUS course sessions during FY17 | 0 | 0 | 0 | 0 | 0 | 0 |
| EG001 | Late Intervention | This cohort of 10 facilities will undergo late training by participating in the last 6 POCUS courses during FY17. | 0 | 0 | 0 | 0 | 0 | 0 |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Nilam Soni | South Texas Veterans Health Care System / UT Health San Antonio | 210-949-9454 | sonin@uthscsa.edu |
| Aug 13, 2019 |
| Prot_SAP_000.pdf |
| ID | Term |
|---|---|
| D006333 | Heart Failure |
| D011014 | Pneumonia |
| D020246 | Venous Thrombosis |
| D002481 | Cellulitis |
| D017544 | Aortic Aneurysm, Abdominal |
| D041881 | Cholecystitis, Acute |
| D006869 | Hydronephrosis |
| D010996 | Pleural Effusion |
| D016055 | Urinary Retention |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D013927 | Thrombosis |
| D016769 | Embolism and Thrombosis |
| D014652 | Vascular Diseases |
| D012874 | Skin Diseases, Infectious |
| D013492 | Suppuration |
| D003240 | Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D007249 | Inflammation |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001014 | Aortic Aneurysm |
| D000783 | Aneurysm |
| D001018 | Aortic Diseases |
| D002764 | Cholecystitis |
| D005705 | Gallbladder Diseases |
| D001660 | Biliary Tract Diseases |
| D004066 | Digestive System Diseases |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D010995 | Pleural Diseases |
| D014555 | Urination Disorders |
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