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Reducing major amputations for rural patients with diabetic foot ulcers: the who’s and how’s of integrated care.

减少农村糖尿病足溃疡患者的大截肢：综合护理的人员和方法。

基本信息

批准号：
10202729
负责人：
Meghan Brennan
金额：
$ 15.7万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10202729
关键词：
Reducing major amputations rural patients

项目摘要

PROJECT SUMMARY ABSTRACT Nearly 2 million Americans develop a diabetic foot ulcer each year. Dr. Brennan's research team and others documented a >50% mortality and 5% major amputation rate within 5-years of ulceration. Next, they determined that morbidity and mortality associated with ulcers disproportionately burdens rural patients, who have 50% higher odds of major amputation and 40% higher odds of death than urban patients. Dr. Brennan's long-term objective is to eliminate this rural disparity through interventions that improve the quality of diabetic foot ulcer care rural patients receive in the ambulatory setting. Over the past decade, many urban tertiary care centers have developed a model of integrated care for patients with diabetic foot ulcers. The integrated care model involves multiple specialists working side-by-side and following a care algorithm to address 4 precipitating physiologic factors in a coordinated manner: poor glycemic control, vascular disease, mechanical complications, and secondary infection. Dr. Brennan's systematic review found that 97% of these urban integrated care clinics reduced major amputation, with relative risk reductions ranging from 11 to 90%. However, this urban model is difficult to implement in the rural setting, where providers are scarce and geographically dispersed. Dr. Brennan's goal is to become an academic clinician-researcher in infectious disease leading an independent research program to improve care and outcomes of diabetic foot ulcers in rural settings. She proposes a 3-year K08 period with training in clinical trials, stakeholder engagement, systems engineering, implementation science, and advanced quantitative skills. Following her KL2 support, Dr. Brennan is well prepared for a successful K08 award period. Her focused training, expert mentorship, and research plan will catalyze her transition to independence. This proposal heralds her advancement from defining gaps in care to closing them. The primary objective of this proposal is to build and pilot an integrated care algorithm adapted to the rural setting. The proposed aims are to: 1) identify which specialists are associated with increased amputation-free survival, and the optimal timing of their involvement 2) co-design an integrated care algorithm and its implementation plan with rural healthcare systems, and 3) pilot the algorithm in the rural setting to maximize adoption and implementation. Upon completion of the proposed research and training, Dr. Brennan will be ideally poised to submit a competitive AHRQ R01 centered on testing the emerging intervention with an effectiveness-implementation study. Her current and future research aims will advance AHRQ's mission by focusing on a high-priority population (rural patients), problem (major amputation), and area of interest (ambulatory care).

项目概要摘要每年有近 200 万美国人患有糖尿病足溃疡。 Brennan博士研究团队等记录了溃疡发生后 5 年内死亡率 >50% 和大截肢率 5%。接下来，他们确定与溃疡相关的发病率和死亡率给农村患者带来了不成比例的负担，他们与城市患者相比，大截肢的几率高出 50%，死亡的几率高出 40%。布伦南博士的长期目标是通过提高糖尿病治疗质量的干预措施来消除这种农村差距农村患者在门诊接受足部溃疡护理。过去十年，许多城市三级医疗中心建立了患者综合护理模式患有糖尿病足溃疡。综合护理模式涉及多名专家并肩工作，遵循护理算法以协调的方式解决 4 个诱发生理因素：血糖不佳控制、血管疾病、机械并发症和继发感染。 Brennan博士的系统回顾发现 97% 的城市综合护理诊所减少了大截肢，相对风险降低范围从 11% 到 90%。然而，这种城市模式很难在农村地区实施，因为供应商稀缺且地理分散。布伦南博士的目标是成为传染病领域的学术临床医生兼研究员，领导独立的研究机构研究计划旨在改善农村地区糖尿病足溃疡的护理和结果。她提议为期3年 K08 阶段包括临床试验、利益相关者参与、系统工程、实施方面的培训科学和先进的定量技能。继 KL2 支持后，布伦南博士已做好充分准备成功的K08颁奖期。她的专注培训、专家指导和研究计划将促进她向独立过渡。这项提案预示着她从界定护理差距到缩小差距的进步。该提案的主要目标是建立并试点适合农村地区的综合护理算法环境。拟议的目标是：1）确定哪些专家与增加免截肢相关生存率，以及他们参与的最佳时机 2) 共同设计一个综合护理算法及其农村医疗保健系统的实施计划，以及 3) 在农村环境中试点该算法，以最大限度地提高通过和实施。完成拟议的研究和培训后，布伦南博士将非常适合提交一份具有竞争力的 AHRQ R01，其重点是通过以下方式测试新兴干预措施：有效性实施研究。她当前和未来的研究目标将通过以下方式推进 AHRQ 的使命：重点关注高优先级人群（农村患者）、问题（大截肢）和感兴趣的领域（门诊护理）。