Yale Clinical and Translational Science Award: Calhoun Diversity in Health Related Research

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CANDIDATE PROJECT ABSTRACT - With the widespread implementation of evidence-based interventions such as prophylactic penicillin and pneumococcal vaccinations, sickle cell disease (SCD) has evolved from a life-threatening disease of childhood to a chronic condition with a strikingly shortened adult life span. SCD patients are at greatest risk for poor outcomes as they transition from pediatric to adult care, a time in which disease progression and socioeconomic complications converge. Evidence suggests that the implementation of structured transition programs to support patients and caregivers will help mitigate many of the challenges that AYA-SCD face as they navigate this complicated landscape. The American Academy of Pediatrics has published a comprehensive guideline, Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home, which has shown promise in improving transition care for adolescents. Nonetheless, there remains a paucity of structured transition programs for adolescents and young adults with SCD. In this proposal, I will use Implementation Science methods to promote the increased uptake of the AAP guidelines into clinical practice with the long-term goal of increasing the presence of structured transition programs for AYA- SCD. To accomplish this objective, I will use Intervention Mapping, an implementation science-based planning framework, to thoughtfully identify a core set of implementation strategies that will facilitate the development of structured transition programs based on the AAP guidelines (Aim 1). I will then pilot these strategies at a local level to evaluate for feasibility and acceptability (Aim 2). These data will inform a multi- center study aimed at using proven implementation strategies in conjunction with AAP guidelines to facilitate the increase of structured transition programs for AYA-SCD with the long-term goal of decreasing morbidity and mortality in this high risk group which is deeply impacted by healthcare inequities. I will leverage the resources at YCCI to successfully execute the proposed project as well as to develop my expertise in Implementation Science, clinical research methods, health equity and intervention design; this includes didactic coursework offered by YCCI, participation in monthly YCCI Research In Progress seminars and continued participation in the Research Opportunities for Clinical and Translational Studies (ROCATS) cohort which provides foundational knowledge to junior faculty committed to clinical and translational research. I will also engage with the YCCI Cultural Ambassadors during study development, execution and dissemination of results to ensure that my scholarly work reflects the needs of the SCD community. With the guidance of my mentorship team, which includes experts in sickle cell disease, implementation science and health equity outcomes research, and the career development resources provided by YCCI I will achieve my long-term goal of becoming an independent physician-scientist dedicated to improving health outcomes in AYA-SCD through the rigorous design and implementation of multi-level health interventions.