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

同伴学习促进经皮冠状动脉介入治疗的质量和适当使用

• 批准号: 10415871
• 负责人: Jacob A Doll
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10415871
• 关键词: Adverse event; Agreement; Attitude; Cardiac; Cardiology; Cardiovascular system; Caring; Clinical; Clinical Data; Clinical Trials; Clinical assessments; Cognitive; Complex; Data; Data Reporting; Development; Doctor of Philosophy; Evaluation; Feedback; Frequencies; Goals; Growth; Health; Healthcare Systems; Hospitals; Intervention; Interview; Investments; K-Series Research Career Programs; Lead; Learning; Measurement; Measures; Medicine; Mentorship; Methodology; Methods; Modeling; Observational Study; Outcome; Patient Preferences; Patients; Peer Review; Performance; Physicians; Pilot Projects; Procedures; Process; Qualitative Methods; Quality of Care; Quality of life; Randomized Controlled Trials; Recommendation; Registries; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Scientist; Site; Stents; Structure; Surveys; System; Techniques; Testing; Time; Training; Training Support; Trust; Universities; Veterans; Washington; arm; behavior change; career; career development; clinical implementation; clinical practice; cost; design; effectiveness trial; evidence base; feasibility testing; implementation outcomes; implementation science; improved; innovation; interest; learning strategy; novel; peer; peer learning; percutaneous coronary intervention; pilot test; preference; professor; programs; provider behavior; randomized controlled study; randomized trial; skills; sound; staff intervention; therapy design; trial design

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.

Jacob Doll博士，医学博士是VA Puget Sound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退伍军人中心和价值驱动护理创新中心， VA临床评估，报告和跟踪（CART）计划。拟议的职业发展 奖（CDA）将通过同行学习改善有创心脏护理的提供，使退伍军人受益 战略，同时提供培训和支持博士娃娃需要成为一个领导者在绩效评估 和反馈，并推动心血管手术护理的创新。 这项研究将开发和测试一种同伴学习干预，促进经皮冠状动脉介入治疗。 干预（PCI）护理质量。PCI，也称为“支架植入术”，是一种常见的心血管手术， 如果使用得当，可以提高生存率和生活质量。然而，临床结果差异很大 在医院和医生中。美国几乎所有的PCI手术都报告给国家登记中心， 质量改进的目的，包括CART计划。尽管有大量的临床数据和大量的 对PCI质量的时间和资源投资，执行PCI的医生没有得到有意义的 反馈他们的实践。需要改进审计和反馈方法。同伴学习是一种 协作质量改进方法，提供详细的，个性化的和可操作的反馈， 临床医生从他们的同事。不必要的PCI手术的性能和技术质量 这对VA来说是特别重要的。在VA进行的选择性手术中，只有24%明确 适当性标准表明，可能会使患者处于风险中而没有获益。提名人 因此，CDA建议设计和测试同伴学习干预，以促进PCI质量， 适当的案例选择。 该建议的具体目标是：1）确定使用同伴学习的障碍和促进因素 通过对VA PCI操作员和关键利益相关者的调查和半结构化访谈; 2）开发和 完善同伴学习干预，为PCI操作员提供可用和可接受的反馈;以及3）试点 测试同伴学习干预，以评估和改善PCI病例选择和技术性能。这 研究将直接有利于退伍军人和VA系统通过提高PCI的质量和增加 适当PCI的频率，从而最大化受益，同时避免不必要的手术风险， 成本它将通过开发一种新的方法，在CART计划的广泛持续投资的基础上， 促进临床实践的变革。最后，它将发展广泛适用的同侪学习方法 到其他领域。该研究计划将直接导致多中心随机对照试验，并最终 发展一个促进医生发展的国家协作同侪学习系统， 护理质量。 为了实现他的研究和职业目标，博士娃娃将获得定性方法的额外技能， 实施科学，行为改变干预措施，并通过课程和指导试验设计 study.他的研究和培训计划将得到一个多元化和合格的导师团队的支持， 包括大卫Au，医学博士，MS（行为改变干预，健康计划的实施，临床试验）， Sunil Rao，医学博士（介入心脏病护理质量、临床试验、观察性研究），Robb MacLellan， MD（职业发展，医生培训，质量改进）和Christian Helfrich，PhD，MPH （实施科学、行为改变干预措施）。 这项拟议的CDA研究，结合强有力的指导和培训计划，将加速 博士多尔作为一名医生科学家和心血管医学的领导者的独立性。