Understanding Real-World Outcomes of Endovascular Treatment of Claudication

项目总结/摘要 外周动脉疾病（PAD），定义为血管狭窄，导致流向 四肢瘫痪是一种常见的诊断，影响近五分之一的美国人，花费超过210亿美元 每年。跛行（行走疼痛）是PAD最常见的表现。的侵入性治疗 尽管缺乏这些程序长期有效的证据，但PAD迅速上升。没有 充分了解这些治疗的长期有效性和提供者的动机 处方这些治疗，决策仍然不清楚。提供有效性的长期数据 治疗策略以及提供者选择治疗的原因将直接改善患者的共同决策- 制作。 本研究提案的目的是描述跛行干预的长期有效性 并探讨提供者治疗决策的动机。这项建议的三个目的是：1） 描述跛行治疗干预措施的长期比较有效性，2）测量 跛行干预治疗效果的异质性，以及3）确定 通过评估提供者对药物治疗、开放手术和 血管内介入。前两个目标将使用来自退伍军人健康中心的新颖的临床丰富数据。 管理，以衡量治疗策略的相对有效性。第三个目标是利用 半结构化访谈，以探讨提供者对治疗有效性的看法和动机， 治疗决定。拟议的研究和培训将为奥斯本博士提供必要的技能， 成为心血管疾病比较有效性研究的领导者， 决策的 博士奥斯本的职业发展将由一个多元化的跨学科团队的指导。 培训将包括研究生水平的高级教学课程，在组织管理，行为和 理论、定性研究方法和实施科学。他将在准备中获得新的技能 手稿和手稿。这种训练将直接导致他发展成为一个独立的 研究者，旨在提高PAD患者的护理质量。该职业发展奖将 为进一步研究提供基础，以制定减少护理差异和改善 治疗PAD患者。

PROJECT SUMMARY/ABSTRACT Peripheral arterial disease (PAD), defined as narrowed blood vessels causing decreased blood flow to the extremities, is a common diagnosis, affecting nearly 1 in 5 Americans and costing more than $21 billion annually. Claudication (pain with walking) is the most common manifestation of PAD. The invasive treatment of PAD has risen rapidly despite a lack of evidence of the long-term effectiveness of these procedures. Without a full understanding of the long-term effectiveness of these treatments and the motivations of providers prescribing these treatments, decision-making remains unclear. Providing long-term data of the effectiveness of treatment strategies and why providers choose treatments will directly improve patient shared decision- making. The goal of this research proposal is to describe the long-term effectiveness of interventions for claudication and to explore the provider motivations for treatment decisions. The three aims of this proposal are: 1) Describe the long-term comparative effectiveness of interventions in the treatment of claudication, 2) Measure the heterogeneity of treatment effects of interventions for claudication, and 3) Identify the key motivators of physician practice by assessing provider perceptions of the effectiveness of medical therapy, open surgery and endovascular interventions. The first two aims will use novel clinically-rich data from the Veterans Health Administration to measure the comparative effectiveness of treatment strategies. The third aim will employ semi-structured interviews to explore provider perceptions of treatment effectiveness and motivations for treatment decisions. The proposed research and training will provide Dr. Osborne with the necessary skills to become a leader in comparative effectiveness research in cardiovascular disease and enhance shared decision-making. Dr. Osborne's career development will be fostered by the mentorship of a diverse interdisciplinary team. Training will include graduate level advanced didactic coursework in organizational management, behavior and theory, qualitative research methods and implementation science. He will acquire new skills in the preparation of manuscripts, and grantsmanship. This training will directly lead to his development into an independent investigator, aimed at improving the quality of care for patients with PAD. This career development award will provide the groundwork for further studies to develop strategies to decrease variation in care and improve the treatment of patients with PAD.