Adaptation and Implementation of Clinical Practice Guidelines to Improve Stroke Outcomes in Zambia

项目总结 这个K01应用程序的目标是为博士提供个性化的指导性研究培训计划。 约翰霍普金斯大学学院神经病学系助理教授迪安娜·塞勒 医学部。自2018年以来，塞勒博士一直全职在赞比亚工作，在那里，与当地 利益相关者，她已经启动了第一个神经科住院患者单元和第一个神经科研究生培训 在该国的项目。塞勒博士正在申请国际研究科学家发展奖，以 获得实施科学研究方面的技能和经验。结合她在临床和医学方面的背景 流行病学研究，这一新技能将使她处于独特的地位，既能产生新知识，又能帮助 开发有效应用新知识以改善患者预后的护理系统。这项研究 本申请中概述的计划利用赞比亚正在发展的神经护理系统来理解 大学教学医院(UTH；赞比亚国家转诊医院)目前的中风护理实践， 制定与当地相关的卒中临床实践指南，并检查其实施对 中风的结果。由于中风是全球成人残疾和死亡的第二大原因， 撒哈拉以南非洲的中风患病率是世界上最高的之一，迫切需要这些数据来 解决这个国家、地区和全球的健康问题。拟议的研究包括一项预先干预 UTH卒中患者的前瞻性队列研究当前卒中护理的临床实践和 卒中结局(目标1)。随后将召集包括相关利益攸关方在内的中风工作组，以 调查社区、患者、提供者和卫生系统导致中风难以实现的因素 质量措施和最佳结果。然后，采用-情景-调整框架将被用于 根据国际卒中指南制定当地相关的临床实践指南以供实施(目的 2)。然后将实施这些指南，并进行干预后的观察性队列研究 检查它们对实现卒中质量措施和改善卒中结果的影响。这款K01将 还支持塞勒博士的培训目标，包括在以下方面获得额外的培训和指导 关键领域：(1)实施科学框架和方法；(2)定性数据方法和 分析；(3)中风临床研究方法，特别是全球独有的方面；以及(4)发展 未来大规模和概括性研究的国际合作者网络。为了实现 为了实现这些目标，塞勒博士建立了一支具有实施专长的国际导师团队 科学、定性研究、中风研究、撒哈拉以南非洲的神经学研究和中风中心 在国际背景下的发展。这一奖项将为塞勒博士提供指导、知识和 成为全球神经病学独立研究员所需的经验，指导临床和 实施研究以改善中风和其他神经疾病患者的预后。

PROJECT SUMMARY The goal of this K01 application is to provide an individualized program of mentored research training for Dr. Deanna Saylor, an Assistant Professor in the Department of Neurology at the Johns Hopkins University School of Medicine. Dr. Saylor has been based full-time in Zambia since 2018 where, in collaboration with local stakeholders, she has launched the first neurology inpatient unit and first neurology post-graduate training program in the country. Dr. Saylor is applying for an International Research Scientist Development Award to gain skills and experience in implementation science research. Combined with her background in clinical and epidemiological research, this new skillset will uniquely position her to both generate new knowledge and help develop care systems that effectively implement new knowledge to improve patient outcomes. The research plan outlined in this application leverages the developing system of neurological care in Zambia to understand current stroke care practices at the University Teaching Hospital (UTH; Zambia's national referral hospital), develop locally relevant stroke clinical practice guidelines, and examine the effect of their implementation on stroke outcomes. Since stroke is the second leading cause of adult disability and mortality worldwide and stroke prevalence in sub-Saharan Africa is amongst the highest in the world, these data are urgently needed to address this national, regional, and global health problem. The proposed research includes a pre-intervention prospective cohort of patients with stroke at UTH to characterize current stroke care clinical practices and stroke outcomes (aim 1). A stroke working group including relevant stakeholders will then be convened to investigate community, patient, provider, and health systems factors leading to difficulty achieving stroke quality measures and optimal outcomes. The Adopt-Contextualize-Adapt framework will then be used to develop locally relevant clinical practice guidelines from international stroke guidelines for implementation (aim 2). These guidelines will then be implemented, and a post-intervention observational cohort study conducted to examine their impact on achieving stroke quality measures and improving stroke outcomes. This K01 will also support Dr. Saylor's training goals which include gaining additional training and mentorship in the following key areas: (1) implementation science frameworks and methodology; (2) qualitative data methods and analysis; (3) stroke clinical research methods, especially aspects unique to global settings; and (4) developing an international network of collaborators for future large-scale and generalizability studies. In order to achieve these goals, Dr. Saylor has established an international team of mentors with expertise in implementation science, qualitative studies, stroke research, neurology research in sub-Saharan Africa, and stroke center development in international settings. This award will provide Dr. Saylor with the mentorship, knowledge, and experience necessary to become an independent investigator in global neurology conducting clinical and implementation research to improve outcomes for patients with stroke and other neurologic disorders.