Implanted but not forgotten: identifying and testing pragmatic strategies to improve inferior vena cava filter retrieval

项目摘要/摘要 作为一名血管和介入放射科医生和卫生服务研究人员，我的长期目标是实现 通过国家护理质量评估和 实施务实发明，提高成果。这项研究和培训计划将使我能够 获得建立独立性所需的关键技能，并推出专注于科学贡献的组合 静脉血栓栓塞症(VTE)相关护理的系统级质量改进。 本研究建议的目标是增加下腔静脉滤器(IVCF)的及时回收和 改善美国患者的预后。下腔静脉滤器在患者中非常常见。 腿部有血栓(深静脉血栓形成；DVT)或肺部有血栓(肺栓塞；PE)，以防止 传播到心脏，这可能是致命的。不幸的是，全国的检索率仍然很低，而且持续时间很长 IVCF植入已经导致了相当大的、可以避免的并发症。最近的多社会指导方针 强调需要通过制定有组织的后续方案来提高IVCF的适时检索率 并更好地了解哪些程序组件在现实世界设置中有效。下一步需要什么 确定和测试实用策略，以改进真实世界环境中的及时IVCF检索。我们 建议通过三个相辅相成的目标来实现这一点：1)量化IVCF检索中的设施水平差异 全美；2)对高绩效机构进行定性描述，以确定最佳实践 并确定其实施的促进者和障碍；3)设计、中试测试和迭代 改编语用干预包以改进IVCF检索，这是由现有文献提供的信息 然后，语用干预将在多中心混合体中进行测试 实施--后续有效性试验，目标是改进IVCF的及时检索和减少 美国各医院的并发症。 我的培训目标与建议的研究方法非常相似，通过重点教育：a) 贝叶斯医院概况，b)定性访谈和分析，以及c)使用 实施科学框架。该培训将通过有计划地混合使用结构化的 课程作业，正式的研讨会经验和与专题研究专家的一对一教育。 我在科罗拉多大学丹佛分校(UCD)的指导团队和研究环境非常理想 适合这项提议。我的主要导师，P.Michael Ho医学博士，是全国心血管领域的领先者 质量评估和务实的干预设计。我还将利用大量数据和 成人和儿童结果研究和交付科学联合会的方法核心资源 (ACCODS)和Data2Value(D2V)倡议在科罗拉多大学实现这些目标。

PROJECT SUMMARY/ABSTRACT As a vascular and interventional radiologist and a health services researcher, my long-term goal is to achieve transformative improvements in vascular procedural care through national quality of care assessments and implementing pragmatic inventions to improve outcomes. This research and training proposal will allow me to gain critical skills needed to establish independence and launch a portfolio of scientific contributions focused on systems-level quality improvement in venous thromboembolism (VTE) related care. The goal of this research proposal is to increase timely retrieval of inferior vena cava filters (IVCF) and improve patient outcomes in the United States. Inferior vena cava filters are very commonly placed in patients with blood clots in the leg (deep venous thrombosis; DVT) or lungs (pulmonary embolism; PE), to prevent propagation to the heart, which can be fatal. Unfortunately, national retrieval rates remain low and prolonged IVCF implantation has resulted in considerable, avoidable morbidity. Multi-society guidelines recently emphasized the need to improve timely IVCF retrieval rates through institution of structured follow up programs and to better understand which program components are effective in real world settings. What is needed next is identification and testing of pragmatic strategies to improve timely IVCF retrieval in real-world settings. We propose to do this via three complimentary aims: 1) quantification of facility-level variation in IVCF retrieval across the United States; 2) qualitative characterization of high-performing institutions to identify best practices and characterize facilitators and barriers to their implementation; 3) design, pilot testing and iterative adaptation of a pragmatic intervention package to improve IVCF retrieval, informed by the existing literature and adapted with findings from aim 2. The pragmatic intervention will then be tested in multi-center hybrid implementation-effectiveness trials to follow, with the goal of improving timely IVCF retrieval and reducing complications across hospitals in the United States. My training aims closely parallel the proposed research methodology through focused education in: a) Bayesian hospital profiling, b) qualitative interviewing and analysis, and c) intervention design using an implementation science framework. This training will be accomplished through an intentional mix of structured coursework, formal workshop experience and one-on-one education with topical research experts. My mentorship team and research environment at the University of Colorado Denver (UCD) are ideally suited to this proposal. My primary mentor, P. Michael Ho MD PhD, is a national leader in cardiovascular quality assessment and pragmatic intervention design. I will additionally leverage the extensive data and methodologic core resources of Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS) and Data2Value (D2V) initiatives at the University of Colorado to accomplish these aims.