Peer learning to promote quality and appropriate use of percutaneous coronary intervention

雅各布·多尔博士是退伍军人事务部普吉特湾医疗保健系统的介入心脏病专家， 华盛顿大学医学系代理助理教授， 西雅图HSR&D以退伍军人为中心和价值驱动的护理创新中心，以及 退伍军人事务部临床评估、报告和跟踪(CART)计划。建议的职业发展 美国疾病控制与预防奖(CDA)将通过同伴学习改善侵入性心脏护理的提供，从而使退伍军人受益 战略，同时提供Doll博士所需的培训和支持，以成为绩效评估的领导者 和反馈，并推动心血管程序性护理的创新。 这项研究将开发和测试一种促进经皮冠状动脉介入治疗的同伴学习干预方法 介入(PCI)护理质量。经皮冠状动脉介入治疗，也被称为“支架植入”，是一种常见的心血管手术，可以 如果使用得当，可提高存活率和生活质量。然而，临床结果差异很大。 在医院和医生之间。在美国，几乎所有的经皮冠状动脉介入治疗程序都要提交给国家登记处 质量改进的目的，包括购物车计划。尽管有如此丰富的临床数据和大量的 投入时间和资源来提高介入治疗质量，进行介入治疗的医生并没有得到有意义的回报 对他们实践的反馈。需要改进审计和反馈的方法。同伴学习是一种 协作式质量改进方法，提供详细、个性化和可操作的反馈 临床医生从他们的同事那里。不必要的经皮冠状动脉介入治疗的性能和技术质量 退伍军人管理局对手术程序特别感兴趣。在退伍军人管理局进行的选择性手术中，只有24%的人明确 由适当性标准指示，潜在地将患者置于没有益处的风险中。这部电影的提名者 因此，CDA建议设计和测试同伴学习干预措施，以促进冠状动脉介入治疗质量和 适当的案例选择。 该提案的具体目标是：1)确定使用同伴学习的障碍和促进者 通过对退伍军人事务部和主要利益相关者的调查和半结构化访谈；2)开发和 完善同行学习干预，为PCI操作员提供有用和可接受的反馈；以及3)试点 测试同行学习干预，以评估和改进PCI案例选择和技术性能。这 研究将直接造福于退伍军人和退伍军人系统，通过改善冠状动脉介入治疗的质量和增加 适当的经皮冠状动脉介入治疗的频率，从而最大化收益，同时避免不必要的程序风险和 成本。它将建立在对CART计划的广泛持续投资的基础上，开发一种新的方法来 推动临床实践变革。最后，它将开发广泛适用的同行学习方法。 到其他领域。该研究计划将直接导致一项多地点随机对照试验，并最终 致力于国家协作同行学习系统的开发，以促进医生发展和 护理质量。 为了实现他的研究和职业目标，多尔博士将在定性方法方面获得更多技能， 实施科学、行为改变干预和通过课程作业和指导的试验设计 学习。他的研究和培训计划将得到一个多样化和合格的指导团队的支持， 包括David Au，医学博士，医学硕士(行为改变干预，健康计划的实施，临床试验)， Sunil Rao，医学博士(介入心脏病学护理质量，临床试验，观察性研究)，Robb MacLellan， 医学博士(职业发展，医生培训，质量改进)，克里斯蒂安·赫尔夫里奇，博士，公共卫生硕士 (实施科学、行为改变干预)。 这项拟议的CDA研究与强有力的指导和培训计划相结合，将加快 多尔博士作为一名内科科学家和心血管医学领袖的独立性。

Dr. Jacob Doll, MD is a Staff Interventional Cardiologist at the VA Puget Sound Health Care System, Acting Assistant Professor in the University of Washington Department of Medicine, Core Investigator at the Seattle HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, and Assistant Director of the VA Clinical Assessment, Reporting, and Tracking (CART) program. The proposed Career Development Award (CDA) will benefit Veterans by improving the delivery of invasive cardiac care through peer learning strategies, while provide the training and support Dr. Doll needs to become a leader in performance evaluation and feedback and to drive innovation in cardiovascular procedural care. This research will develop and test a peer learning intervention that promotes percutaneous coronary intervention (PCI) care quality. PCI, also known as “stenting,” is a common cardiovascular procedure that can improve survival and quality of life when used appropriately. However, clinical outcomes vary significantly among hospitals and physicians. Nearly all PCI procedures in the US are reported to national registries for quality improvement purposes, including the CART program. Despite this wealth of clinical data and substantial investment of time and resources to PCI quality, physicians who perform PCI are not receiving meaningful feedback about their practice. Improved methods of audit and feedback are needed. Peer learning is a collaborative quality improvement method that provides detailed, personalized, and actionable feedback to clinicians from their colleagues. The performance of unnecessary PCI procedures and the technical quality of procedures are of particular interest to VA. Of elective procedures performed at VA, only 24% are clearly indicated by appropriateness criteria, potentially putting patients at risk without benefit. The nominee for this CDA therefore proposes to design and test a peer learning intervention that promotes PCI quality and appropriate case selection. The specific aims of the proposal are: 1) Identify barriers and facilitators to the use of peer learning through surveys and semi-structured interviews with VA PCI operators and key stakeholders; 2) Develop and refine a peer learning intervention that provides usable and acceptable feedback to PCI operators; and 3) Pilot test a peer learning intervention to assess and improve PCI case selection and technical performance. This research will directly benefit Veterans and the VA system by improving the quality of PCI and increasing the frequency of appropriate PCI, thereby maximizing benefit while avoiding unnecessary procedural risks and costs. It will build on the extensive ongoing investment in the CART program by developing a novel method for promoting clinical practice change. Finally, it will develop methods of peer learning that are broadly applicable to other fields. The research program will lead directly to a multi-site randomized controlled trial and ultimately to the development of a national collaborative peer learning system that promotes physician development and care quality. To achieve his research and career goals, Dr. Doll will acquire additional skills in qualitative methods, implementation science, behavior change interventions, and trial design through coursework and directed study. His research and training plan will be supported by a diverse and well-qualified mentorship team that includes David Au, MD, MS (behavior change interventions, implementation of health programs, clinical trials), Sunil Rao, MD (interventional cardiology care quality, clinical trials, observational research), Robb MacLellan, MD (career development, physician training, quality improvement), and Christian Helfrich, PhD, MPH (implementation science, behavior change interventions). This proposed CDA research, in combination with robust mentorship and training plans, will accelerate Dr. Doll's independence as a physician-scientist and leader in cardiovascular medicine.