Drug-use associated infective endocarditis: Post-hospitalization outcomes and patient treatment preferences

药物使用相关的感染性心内膜炎：住院后的结果和患者的治疗偏好

• 批准号: 10373998
• 负责人: Asher Jacob Schranz
• 金额: $ 17.61万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10373998
• 关键词: Accounting; Address; Antibiotic Therapy; Antibiotics; Area; Award; Behavioral; Cardiac Surgery procedures; Caring; Clinical; Communicable Diseases; Data; Data Set; Death Records; Demographic Factors; Development; Disease; Drug Metabolic Detoxication; Drug Use Disorder; Drug usage; Emergency Situation; Endocarditis; Epidemiologist; Epidemiology; Evaluation; Fostering; Foundations; Funding; Future; Goals; Health Services Accessibility; Health Services Research; Heart Valves; Hospital Charges; Hospital Costs; Hospital Referrals; Hospitalization; Hospitals; Human Subject Research; Incidence; Individual; Infection; Infectious Diseases Research; Infective endocarditis; Injections; Inpatients; Instruction; Insurance; Intervention; Interview; Intravenous; Knowledge; Length of Stay; Life; Link; Medicaid; Mentors; Mentorship; Morbidity - disease rate; North Carolina; Operative Surgical Procedures; Outcome; Overdose; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Population; Public Health; Qualitative Research; Questionnaires; Recurrence; Relapse; Repeat Surgery; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Role; Scientist; Structure; Surveys; System; Training; Treatment Protocols; Uninsured; Universities; Visit; Work; addiction; adverse outcome; behavioral health; career; experience; future implementation; heart damage; heart valve replacement; high risk; hospital readmission; improved; injection drug use; medical complication; mortality; novel; opioid epidemic; patient safety; preference; prevent; response; risk perception; skill acquisition; skills; treatment guidelines

PROJECT SUMMARY/ABSTRACT Hospitalizations for drug use-associated infective endocarditis (DUA-IE), an infection of the heart valves from injecting drugs, have increased sharply as a consequence of the opioid epidemic. DUA-IE is a severe disease that poses substantial morbidity to patients and burden to hospitals and insurance payers. Treatment typically requires long hospitalizations, six weeks of intravenous antibiotics and often includes surgical heart valve replacement. The post-hospitalization course of patients with DUA-IE has not been well-studied. During treatment, many patients’ drug use disorders (DUDs) remain unaddressed, despite their central role in causing DUA-IE, leaving patients vulnerable to ongoing drug-related risks such as overdose and repeat DUA-IE. Understanding how to address DUDs for hospitalized patients with DUA-IE, particularly in areas with limited treatment resources, is critically important. The overall objectives of this work are to characterize DUA-IE patients’ post-discharge course to understand the scope and timing of negative clinical outcomes, and to explore DUA-IE patients’ perspectives to identify strategies to foster engagement in DUD and infectious disease care. In North Carolina, a Medicaid non-expansion state, we will evaluate three research aims: (1) Estimate incidence rates of and risk factors for adverse outcomes following hospitalization for DUA-IE including: drug overdose, readmission, reoperation, and all-cause mortality; (2) Explore knowledge, preferences, and perceptions of DUA- IE risk, post-hospitalization drug use, DUD treatment, and antibiotic options among hospitalized DUA-IE patients; and (3) Pilot a multicenter survey characterizing DUA-IE patients’ knowledge, preferences, and perceptions of DUA-IE and DUD, access to care, and treatment preferences. Completion of these aims aligns with a training objective to obtain skills across five specific domains: (1) epidemiologic analysis of administrative datasets, (2) exploratory qualitative research, (3) developing and analyzing questionnaires, (4) collaborative, management and project development, and (5) the responsible conduct of human subjects research. This training will be accomplished through coursework, one-on-one instruction and guidance from a diverse group of mentors and advisors from across the University of North Carolina, Duke University and the North Carolina Division of Public Health, including experts in health services research for infectious diseases, DUD care, multisite studies of infective endocarditis and behavioral health. Completion of the research and training aims represent short-term career goals, but they will also form a foundation for my future academic endeavors. My long-term goal is to become an independent investigator with expertise in the infectious complications of drug use, and to be prepared to implement interventions and to answer new epidemiologic and behavioral questions that arise. This research and training plan is foundational to the future implementation and evaluation of an inpatient intervention to enhance post-discharge outcomes for DUA-IE, which I will propose in an R01 towards the end of the award as I transition to research and funding independence.

项目摘要/摘要 药物使用相关感染性心内膜炎（DUA-IE）的住院 注射药物由于阿片类药物流行而急剧增加。 dua-ie是一种严重的疾病 这给患者带来了大量发病率，并向医院和保险付款人燃烧。通常治疗 需要长时间的住院时间，六周的静脉注射抗生素，通常包括手术心脏瓣膜 替代品。 DUA-IE患者的院后病程尚未得到充分研究。期间 治疗，许多患者的药物使用障碍（DUDS）仍然没有解决 Dua-ie，使患者容易受到持续的与药物有关的风险，例如过量和重复DUA-IE。 了解如何针对住院的DUA-IE患者来解决DUDS，特别是在有限的地区 治疗资源至关重要。这项工作的总体目标是表征dua-ie 患者的入院后课程，以了解负临床结果的范围和时间，并探索 DUA-IE患者的观点是确定促进DUD和传染病护理参与的策略。在 北卡罗来纳州是一种医疗补助州的非膨胀状态，我们将评估三个研究目的：（1）估计事件 DUA-IE住院后不良后果的率和危险因素，包括：药物过量， 再运行，重新手术和全因死亡率； （2）探索对DUA-的知识，偏好和看法 IE风险，院后药物使用，DUD治疗和抗生素选择中的DUA-IE患者； （3）试验一个表征DUA-IE患者知识，偏好和看法的多中心调查 dua-ie和dud，获得护理和治疗偏好。这些目标的完成与培训一致 目的是在五个特定领域获得技能：（1）行政数据集的流行病学分析，（2） 探索性定性研究，（3）制定和分析问卷，（4）协作，管理 和项目开发，以及（5）人类受试者研究的负责任行为。这个培训将是 通过课程，一对一的指导和指导的指导 北卡罗来纳大学，杜克大学和北卡罗来纳州公共部的顾问 卫生，包括卫生服务专家的传染病研究专家，DUD护理，多站点研究 感染性心内膜炎和行为健康。研究和培训目标的完成代表了短期 职业目标，但它们还将为我未来的学术努力奠定基础。我的长期目标是 成为在吸毒的传染性并发​​症专家的独立研究者，并成为 准备实施干预措施并回答出现的新流行病学和行为问题。这 研究和培训计划是未来实施和评估住院干预的基础 为了提高DUA-EIE的分期收费结果，我将在奖励结束时在R01中提出。 当我过渡到研究和资助独立性时。