K12 IMPACT Update

September 2020

The K12 IMPACT (IMPlementation to Achieve Clinical Transformation) Program in dissemination and implementation science, with five years of funding from NHLBI, is a two-year career development program that prepares a diverse group of post-doctorate scholars for careers in T4 translational research with an emphasis on heart, lung, blood and sleep (HLBS) disorders.  As was the case with all fellowships on campus, in March we had to begin running the program remotely.  Holding our weekly work-in-progress sessions by Zoom was an easy transition, but several of our scholars experienced delays in progressing with their research projects.  Despite these setbacks, however, one of our six scholars, Dr. Anna Maw, was able to apply for and receive funding $25,000 dollars from CCTSI for a year-long COVID-19 study at UCH.

Dr. Maw’s research, including prior to the pandemic, has focused on point of care lung ultrasound (LUS) as a practical imaging alternative to chest x-rays and computed tomography (CT). She notes in her proposal that patients hospitalized with COVID-19 infections, particularly elderly adults, are at a high risk for respiratory failure due to interstitial pneumonia. In contrast with chest x-rays and CT, LUS is performed by the treating clinician at the patient’s bedside, and is a highly accurate and practical imaging method that thusly limits potential COVID-19 exposure to and by radiology technicians, as well as further conserves personal protective equipment (PPE).  Through meta-analysis, she and others on her research team have demonstrated that LUS is more sensitive than chest x-ray in the detection of pulmonary edema, the earliest finding in lung damage due to this infection.  LUS has also been shown to be more accurate than chest x-ray in identifying pulmonary consolidation, a later finding in COVID’s lung involvement.  Further, Dr. Maw notes that LUS is easy to learn and perform with excellent interrater reliability, but that despite the fact that multiple societal guidelines currently endorse its use, few clinicians outside of emergency care and critical care put it into practice.  Traditionally, cost and lack of portability have been the key barriers to LUS application; however, hand-held machines with good image quality can now be purchased for roughly $2000 dollars, greatly mitigating the aforementioned limitations to broader implementation.

Using the methods of implementation science, Dr. Maw argues for hospitalists’ implementation of LUS in the management of suspected or diagnosed patients with COVID-19 as a means for conserving PPE, reducing the risk of transmission to technicians, and conserving the resources of radiology services that would otherwise be overwhelmed by infected patients in need of chest imaging.  Her funded proposal specifically advances the following two aims:

  • Aim 1a: Using a rapid-cycle weekly Plan-Do-Study-Act cycle and Rapid Iterative RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to optimize the implementation of LUS by adult hospitalists in the management of COVID-19 patients in a pilot study
  • Aim 1b: Evaluate this pilot implementation of LUS by adult hospitalists using the RE-AIM framework

Congratulations to Dr. Anna Maw on this funded proposal!  To learn more about our scholars and the K12 IMPACT Program, we invite you to visit our website at the following URL: https://medschool.cuanschutz.edu/accords/research-publications/research-training/impact-k12-training-program