Developing and Implementing Evidence-Based Hernia Care

制定和实施循证疝气护理

• 批准号: 10186799
• 负责人: Dana Alexa Telem
• 金额: $ 14.03万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186799
• 关键词: Developing; Implementing; Evidence; Based; Hernia

Project Summary Abdominal wall hernia repair is one of the most common operations performed in the United States. Despite nearly every general surgeon in the country performing hernia repair, it remains the most systematically understudied surgical procedure. Considerable variability in surgical approach exists for even the most basic hernias. This variability results in suboptimal patient outcomes, both long and short term, as well as a 3.2-billion-dollar cost to the healthcare system. The lack of comparative effectiveness research impedes evidence-based practice. There are three key knowledge gaps to be addressed. First, we do not understand the relationship between different surgical approaches, (e.g., minimally invasive and open) for hernia repair and patient outcomes. Second, it is unclear whether it is necessary to tailor surgical approach based on patient characteristics. Finally, the barriers and enablers to adoption of evidence-based practice across hernia surgeons have not been explored. This proposal will address these key gaps. Leveraging the capital from two unique data registries, the America Hernia Society Quality Collaborative (AHSQC) and the Michigan Surgery Quality Collaborative (MSQC), we will explore the effectiveness of commonly employed surgical approaches by hernia type and patient characteristics. Synthesizing this data with relevant comparative effectiveness literature, we will develop evidence-based hernia recommendations and qualitatively assess the barriers and facilitators to surgeon implementation of the proposed recommendations. The aims of this research proposal are to 1) Evaluate the comparative effectiveness of commonly performed surgical techniques for hernia repair 2) Identify heterogeneity in comparative effectiveness of hernia repair by patient subgroups 3) Identify the barriers and facilitators to implementation of evidence-based hernia practice, based on hernia and patient characteristics. In addition to the innovative research plan, this proposal will provide the career development candidate (Dana Telem) with a rich mentorship experience. It will also provide her with the methodologic training in comparative effectiveness research and a strong theoretical background in implementation science. This project will lay the groundwork for Dr. Telem to become an independent investigator focused on developing and implementing evidence-based approaches for common surgical problems.

项目摘要 腹壁疝修补术是美国最常见的手术之一。 尽管几乎每个普通外科医生在该国进行疝修补术，它仍然是最 系统性的未充分研究的外科手术。即使是在外科手术中， 最基本的疝气这种可变性导致长期和短期的次优患者结局， 以及32亿美元的医疗系统成本。缺乏比较有效性研究 阻碍了循证实践。有三个关键的知识差距需要解决。首先，我们不 了解不同手术方法之间的关系，（例如，微创和开放）， 疝修补术和患者结局。第二，目前还不清楚是否有必要量身定制手术入路 根据患者的特点。最后，采用循证实践的障碍和推动因素 疝气外科医生之间的关系还没有被探索过。本提案将解决这些关键差距。借力 来自两个独特数据登记处的资金，美国疝学会质量协作（AHSQC）和 密歇根外科质量协作（MSQC），我们将探讨常用的有效性， 根据疝类型和患者特征确定手术入路。将这些数据与相关的 比较有效性文献，我们将制定基于证据的疝建议， 评估外科医生实施拟议建议的障碍和促进因素。的目的 本研究的目的是：1）评价常用外科手术的比较有效性， 疝修补术技术2）确定患者疝修补术相对有效性的异质性 亚组3）确定实施循证疝实践的障碍和促进因素， 疝气和病人的特征除了创新的研究计划外，该提案还将提供 职业发展候选人（Dana Telem），具有丰富的导师经验。这也将为她提供 在比较有效性研究中的方法论培训和在以下方面的强大理论背景： 执行科学。这个项目将为Telem博士成为一名独立的 研究者专注于开发和实施循证方法， 问题

项目成果

Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.

年龄和种族差异接受微创腹股沟疝修补术的机制。

• DOI: 10.1007/s00464-019-06695-0
• 发表时间: 2019
• 期刊: Surgical endoscopy
• 作者: Vu,JocelineV;Gunaseelan,Vidhya;Dimick,JustinB;Englesbe,MichaelJ;CampbellJr,DarrellA;Telem,DanaA
• 通讯作者: Telem,DanaA

Bariatric Surgery in Medicare Patients: Examining Safety and Healthcare Utilization in the Disabled and Elderly.

• DOI: 10.1097/sla.0000000000004526
• 发表时间: 2022-07-01
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Chao GF;Chhabra KR;Yang J;Thumma JR;Arterburn DE;Ryan AM;Telem DA;Dimick JB
• 通讯作者: Dimick JB

Postacute Care Utilization and Episode of Care Payments Following Common Elective Operations.

常见选择性手术后的急性期护理利用和护理付款情况。

• DOI: 10.1097/sla.0000000000004814
• 发表时间: 2023
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Ehlers,AnneP;Howard,Ryan;Lai,Yen-Ling;Waljee,JenniferF;Delaney,LiaD;Nathan,Hari;Dimick,JustinB;Telem,DanaA
• 通讯作者: Telem,DanaA

Out-of-Pocket Spending on Common Operations Among the Commercially Insured.

商业投保人在共同业务上的自付费用。

• DOI: 10.1097/sla.0000000000005081
• 发表时间: 2022
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Chhabra,KaranR;Scott,JohnW;Yang,Jie;Fan,Zhaohui;Dimick,JustinB;Telem,DanaA
• 通讯作者: Telem,DanaA

Volume-outcome relationships for Roux-en-Y gastric bypass patients in the sleeve gastrectomy era.

袖状胃切除术时代 Roux-en-Y 胃绕道手术患者的容量与结果关系。

• DOI: 10.1007/s00464-021-08705-6
• 发表时间: 2022
• 期刊: Surgical endoscopy
• 作者: Chao,GraceF;Yang,Jie;Thumma,Jyothi;Chhabra,KaranR;Arterburn,DavidE;Ryan,Andrew;Telem,DanaA;Dimick,JustinB
• 通讯作者: Dimick,JustinB