# Strengthening implementation science in Acute Respiratory Failure using multilevel analysis of existing data

> **NIH NIH R21** · JOHNS HOPKINS UNIVERSITY · 2024 · $124,681

## Abstract

PROJECT SUMMARY
Up to 1 million Americans experience acute respiratory failure (ARF) and require mechanical ventilation in an
intensive care unit annually. Studies repeatedly revealed incomplete penetration of proven-effective,
sometimes life-saving, evidence-based practices (EBP) for these patients, and it is unclear how to select
optimal implementation strategies that can bridge the gap between evidence and practice. Common
approaches to selection have inherent limitations. For example, concept mapping and implementation mapping
rely heavily on stakeholder perspectives, are labor-intensive, and may focus on stakeholder preferences
instead of strategies with the greatest potential impact. Quantitative approaches are also challenging because
important determinants of practice - such as individual motivation and organizational culture - are difficult to
measure at scale.
One important goal of implementation is to reduce variability in the uptake of EBPs attributable to
clinicians and the environmental setting. While clinical practice should vary in response to patient factors and
preferences, implementation programs try to overcome clinician and environmental factors (e.g. insufficient
knowledge or resources) that limit EBP uptake. Applying the Consolidated Framework for Implementation
Research (CFIR) to this conceptual model, the domains of Individuals and Inner Setting should have minimal
influence on adherence to EBPs after a successful critical care implementation program. We hypothesize that
variability attributable to the CFIR domains of Individuals and Inner Setting is lower among patients when a
treatment is supported by high-quality evidence compared to patients for whom the existing evidence for a
treatment is weaker. Our overall objective is to demonstrate 1) how established multilevel modeling techniques
can be used to estimate the proportion of variation in the use of EBPs that is attributable to the CFIR domains
of Inner Setting and Characteristics of Individuals, and 2) how the resulting information can inform selection of
implementation strategies and evaluate their effectiveness. As a proof of concept, we will study two proveneffective
interventions - low tidal volume ventilation for acute respiratory distress syndrome and bag mask
ventilation during intubation. We will use existing multicenter datasets from the Low Tidal Volume Universal
Support: Feasibility of Recruitment for lnterventional Trial (LOTUS-FRUIT) cohort study and from 3 randomized
trials that collected data on the use of bag-mask ventilation.

## Key facts

- **NIH application ID:** 10888386
- **Project number:** 5R21HL167175-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Alison Turnbull
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $124,681
- **Award type:** 5
- **Project period:** 2023-07-15 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10888386

## Citation

> US National Institutes of Health, RePORTER application 10888386, Strengthening implementation science in Acute Respiratory Failure using multilevel analysis of existing data (5R21HL167175-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10888386. Licensed CC0.

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