ABOUT iIMPROVE PSP
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Evidence & Translation
- Conservative versus interventional treatment for spontaneous pneumothorax – Monash University
- Does Size matter?
- Current practices and attitudes
- All Peer reviewed publications
The Need
An elegantly simple problem, we should be treating the vast majority of patients with moderate and large primary spontaneous pneumothorax (PSP) with a watchful waiting approach and avoiding unnecessary, painful and costly interventions.
Although the solution may seem simple, this paradigm shift in PSP management requires the reversal in decades of medical training, practice and dogma, driven by a health system seeped in perverse incentives and lacking consumer engagement and intervention bias.
‘Guidelines, key notes and education won’t address this implementation gap, to deliver high-value care – an implementation trial will achieve this’.
Our Approach
iIMPROVE PSP is an implementation trial based upon validated tools and frameworks to accelerate the conservative management of PSP nationally. It will guide and empower clinician and consumers to engage in authentic shared decision making. iIMPROVE PSP will deliver rapid best practice change nationally during the grant period. Following 18 health services participants to determine implementation effectiveness.
The study will be delivered through four essential work packages:
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.
To determine the implementation effectiveness of iIMPROVE PSP pathway at scale. Evaluation will use the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework.
A within-trial cost-effectiveness analysis to prove a complelling case for scale-up and economic modelling for longer-term benefits
Will include a survey, implementation tool kit 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.
Impact
The iIMPROVE PSP project will deliver significant reductions in health service costs and avoidable patient harm, representing exceptional value for money. Our exploratory cost analysis suggests potential savings of approximately $20,000 per patient through conservative management. However, the most compelling benefit lies in preventing the avoidable harm currently experienced by consumers, harm that this project is designed to rapidly and effectively reduce.
The iIMPROVE project directly addresses key research and translation gaps that hinder the adoption of national clinical guidelines across complex and diverse health service settings.
High-quality evidence clearly demonstrates that this approach is safe and leads to reductions in iatrogenic harm, hospital admissions, recurrence, surgical intervention, and time off work. Ultimately, it enables the delivery of high value care that improves outcomes for consumers while enhancing the sustainability of the health system.
Funding
The implementation science trial is funded by Medical Research Future Fund MRFF 2023 Clinical Trial Activity. Amount: $4,7 Million. Grant Duration: 5 Years.
Coordinating Organisation
The school of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia.
Clinical Trials Register
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Officially Endorsed By:
Australasian College for Emergency Medicine (ACEM) Clinical Trials Network.