A project to transform the hospital treatment of collapsed lungs in Australia has received a $4.7 million 2023 Medical Research Future Fund (MRFF) Clinical Trials Activity Grant from the National Health and Medical Research Council (NHMRC).
Director of Emergency Medicine Research at Monash Medical Centre Professor Diana Egerton-Warburton, who is also Conjoint Professor of Emergency Care Research from the School of Clinical Sciences at Monash Health, will lead the ‘iIMPROVE PSP’ implementation science study to improve outcomes in primary spontaneous pneumothorax (PSP), a type of collapsed lung that occurs without any apparent cause.
The multidisciplinary research team will work with partner national and jurisdictional organisations around Australia including the Australian Commission on Safety and Quality in Health Care, Australasian College for Emergency Medicine, Safer Care Victoria, Centre for Clinical Research in Emergency Medicine, Monash Partners, Emergency Medicine Foundation, the Institute for Respiratory Health, Lung Foundation Australia and NSW Agency for Clinical Innovation. Health services, including Monash Health and Alfred Health, will also participate in the four-part project to implement best evidence, reduce low-value care and improve patient outcomes.
Professor Egerton-Warburton said that while the solution may seem simple – to just ‘do less’ – a paradigm shift in PSP management requires the reversal of decades of medical training, practice and dogma, driven by a health system steeped in perverse incentives and lacking consumer engagement and intervention bias.
‘Guidelines, keynotes and education alone won’t address this implementation gap, to deliver high-value care, an implementation trial will achieve this,’ Professor Egerton-Warburton said.
‘Using the Learning Health System Framework, we will engage stakeholders and together with a powerful team of researchers led by Monash University, will implement best evidence, reduce low-value care and patient harm in an effective, sustainable and nationally scalable way.’
The team will use a similar methodology developed for their 2021 MRFF Clinical Trials Activity funded project on reducing unhelpful intravenous cannulation.
The project will involve four essential work packages:
- Stakeholder engagement, evidence synthesis and iIMPROVE PSP pathway development. The team will co-design, evidence-based, tailored, consumer-focused PSP care pathways based on their previous research, evidence synthesis and guidelines, developed by and with consumers using established behaviour change and Learning Health System (LHS) frameworks to answer how to implement high-value care in complex systems.
- A stepped wedge cluster randomised trial to determine the implementation effectiveness of iIMPROVE PSP pathway at scale. Evaluation will use the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework.
- Economic Evaluation of iIMPROVE PSP pathway. A within-trial cost-effectiveness analysis will provide a compelling case for scale-up and economic modelling for longer-term benefits.
- The roadmap for national scale-up will include a survey, implementation toolkits and National Clinical Care Standard co-designed with stakeholders including the Australian Commission for Safety and Quality in Healthcare. This will build legacy implementation research capacity in emergency and respiratory care and drive future collaborative research.
‘This is an elegantly simple problem; we should be treating the vast majority of patients with primary spontaneous pneumothorax (PSP) with a watchful waiting approach and therefore avoid unnecessary, painful and costly interventions,’ Professor Egerton-Warburton said.
‘High-level evidence clearly demonstrates that this approach is safe and will reduce iatrogenic harm, hospital admissions, recurrence, surgery and days off work. It will deliver high-value care that is better for consumers and the health system.’
Having two spontaneous pneumothoraxes, the project’s consumer lead investigator Ethan has personally experienced the pain of the typical treatment for PSP. His experience will offer the research team insight into the unnecessary harm that patients can experience when old, outdated guidelines are followed when providing care.
Ethan said that the chest-tube treatment he received caused more pain and discomfort than the collapsed lung itself.
‘I feel like the pain and scarring I experienced was due to a lack of evidence-informed practice,’ he said.
‘I’m grateful that I have the opportunity to contribute to this research project, and that my experience can be used to improve care across Australia. I’m hopeful that through this research, people will receive more effective care for PSP, without unnecessary pain.’
This article has been reproduced with permission. The original article can be found here: Project to transform primary spontaneous pneumothorax treatments nationally awarded 2023 MRFF Clinical Trials Activity Grant – Medicine, Nursing and Health Sciences