Novel Assessment of the Role of Surgery in Recurrent Diverticulitis

项目摘要/摘要 乙状结肠憩室病是美国卫生系统的重大负担。并发症导致 到相当高的发病率和死亡率。2004年，憩室病导致313,000人死亡 在美国，住院治疗、190万次门诊护理和3365例死亡。适应症： 慢性或复发性憩室炎的外科治疗知之甚少。 许多研究表明，择期手术对死亡的益处微乎其微。 憩室病。正因为如此，传统的手术结果，如30天的存活，伤口 发病率和住院并发症是分析这一问题的较差指标。 这份提案描述了一个结直肠外科医生的职业发展计划，它将使我能够使用 我75%受保护的努力，以发展定性分析、患者报告的结果、比较 有效性，以及纵向数据分析。研究的具体目的是：1)调查比对 患者和外科医生的目标和期望之间；2)分析手术对功能的影响 和复发性憩室炎患者的生活质量；以及3)评估手术对医疗保健的影响 复发性憩室炎的利用、旷工和经济毒性。 职业发展计划包括：a)先进的课程和个性化的导师指导 有关定性方法、患者报告的结果和手术比较效果的指导 技术，b)参加地方/国家研讨会和会议，以增进质量和技术方面的专门知识 患者报告结果发展的量化方面，c)多学科指导性研究 经验，以及d)高度支持的研究环境。该环境包括健康中心 服务研究，手术质量和结果研究中心，AHRQ资助的证据- 基础实践中心，一流的皮博迪教育学院，公共卫生硕士项目，以及 范德比尔特大学外科系。 总体而言，这个职业发展奖将提高我在定性方法方面的能力，患者报告 通过提供传授教育和体验式教育的成果和比较效果研究 对久经考验的导师的监督。我们将生成有关功能和生活质量结果的重要数据 适用于憩室病患者。重要的是，该奖项为无缝过渡提供了关键支持 面向未来独立资助的研究，这些研究使用患者报告的结果进行比较 有效性研究，以更好地了解手术在慢性病状态中的作用，包括 憩室病和其他疾病。

PROJECT SUMMARY/ABSTRACT Diverticulosis of the sigmoid colon is a significant burden to the US health system. Complications lead to substantial morbidity and mortality. In 2004, diverticular disease was responsible for 313,000 hospitalizations, 1.9 million ambulatory care visits, and 3365 deaths in the United States. Indications for surgical management of chronic or recurrent diverticulitis are poorly understood. A number of studies have revealed that there is minimal mortality benefit to elective surgery for diverticular disease. Because of this, traditional surgical outcomes, such as 30-day survival, wound morbidity and in hospital complications are poor metrics to analyze this problem. This proposal describes a career development plan for a colorectal surgeon that will enable me to use my 75% protected effort to develop expertise in qualitative analysis, patient reported outcomes, comparative effectiveness, and analysis of longitudinal data. The research specific aims are: 1) to investigate alignment between the goals and expectations of patients and surgeons; 2) analyze the effect of surgery on the function and quality of life of patients with recurrent diverticulitis; and 3) assess the effect of surgery on health care utilization, work absenteeism and financial toxicity in recurrent diverticulitis. The career development plan integrates: a) advanced coursework and individualized mentor-directed instruction in qualitative methodology, patient reported outcomes, and surgical comparative effectiveness techniques, b) participation in local/national seminars and conferences to advance expertise in qualitative and quantitative aspects in development of patient reported outcomes, c) a multidisciplinary mentored research experience, and d) a highly supportive research environment. This environment includes the Center for Health Services Research, the Center for Surgical Quality and Outcomes Research, an AHRQ-funded Evidence- based Practice Center, a top-ranked Peabody School of Education, a Masters in Public Health program, and the Vanderbilt University Department of Surgery. Overall, this career development award will advance my ability in qualitative methods, patient reported outcomes and comparative effectiveness research by providing both didactic and experiential education under the supervision of proven mentors. We will generate important data on functional and quality of life outcomes for patients with diverticular disease. Importantly, this award provides critical support to seamlessly transition toward future independently funded studies that use patient reported outcomes to conduct comparative effectiveness studies to better understand the role of surgery in chronic disease states, including both diverticular disease and other disorders.