# Implementation of behavioral economic approaches to improve evidence uptake for mechanically ventilated patients

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2022 · $769,908

## Abstract

PROJECT SUMMARY
By some estimates, up to one million Americans undergo invasive mechanical ventilation (MV) each year. MV
can be life-saving, but can also be harmful by leading directly to lung injury by delivering artificially large
breaths. A growing body of evidence has demonstrated that a specific strategy of “lung-protective ventilation”
(LPV), which entails smaller breaths and reduced airway pressures, can reduce both short-term mortality and
long-term morbidity. Among patients with acute respiratory distress syndrome (ARDS), a form of severe
respiratory failure associated with common illnesses such as pneumonia, sepsis, and trauma, high-quality
evidence has demonstrated that LPV reduces mortality, duration of mechanical ventilation, and long-term
morbidity of patients with ARDS. Nonetheless, many patients with ARDS who undergo mechanical ventilation
do not receive this life-saving therapy. Two reasons for this poor evidence uptake are lack of knowledge about
LPV and uncertainty regarding who has ARDS at the time of MV initiation. However, recent recognition that
LPV may improve outcomes even among patients without ARDS suggests that encouraging clinicians to begin
with LPV for all patients may be an optimal strategy. Therefore, our main objective is to study simple strategies
that may circumvent the barriers of knowledge and diagnostic uncertainty, to improve the utilization of LPV. We
will conduct a large pragmatic trial of electronic health record (EHR)-based implementation strategies informed
by behavioral economic principles to encourage LPV utilization among all MV patients. We will employ a
Hybrid Trial Type 3 design to study implementation and effectiveness outcomes. We will test two hypotheses:
(1) that a default order set (pre-populated with LPV settings) or an accountable justification prompt (requiring
physicians to provide an explicit rationale when non-LPV settings are ordered) will increase LPV utilization
among patients with and without ARDS, will be sustainable, and will improve overall clinical outcomes; and (2)
that the addition of an accountable justification prompt requiring respiratory therapists to provide a rationale
when non-LPV settings are documented will further improve outcomes. We will use a stepped-wedge, cluster
randomized design across 12 ICUs. The specific aims of this trial are to: (1) compare fidelity to LPV with the
implementation strategies; (2) evaluate the sustainability of the strategies and their effects; (3) explore whether
clinician and environmental contextual factors modify the effect of the strategies; (4) compare the effectiveness
of strategies to improve patient outcomes; (5) compare the specific efficacy of these strategies, accounting for
imperfect adherence to LPV; and (6) evaluate how patient heterogeneity interacts with the strategies. This
study will provide high-quality evidence regarding the ability of simple, readily scalable interventions to improve
evidence-based practices among pa...

## Key facts

- **NIH application ID:** 10370335
- **Project number:** 5R01HL141608-04
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Meeta Prasad Kerlin
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $769,908
- **Award type:** 5
- **Project period:** 2019-03-15 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10370335

## Citation

> US National Institutes of Health, RePORTER application 10370335, Implementation of behavioral economic approaches to improve evidence uptake for mechanically ventilated patients (5R01HL141608-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10370335. Licensed CC0.

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