Understanding Variation in Treatment Intensity with Lower Extremity PAD

了解下肢 PAD 治疗强度的变化

• 批准号: 8267739
• 负责人: Philip P Goodney
• 金额: $ 13.99万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8267739
• 关键词: Affect; African American; American; Amputation; Atlases; Award; Benefits and Risks; Blood Vessels; Bypass; Care given by nurses; Caring; Characteristics; Clinical; Clinical Data; Clinical Pathways; Clinical Sciences; Comorbidity; Consultations; Cost Analysis; Data; Data Set; Development Plans; Effectiveness; Elements; Ensure; Environment; Evaluation; Expenditure; Fellowship; Fostering; Funding; Gender; Goals; Health Care Delivery Study; Health Policy; Health Services Research; Healthcare; Hospitals; Image; Independent Living; Institutes; Intervention; Knee; Knowledge; Learning; Length of Stay; Link; Lower Extremity; Master' s Degree; Measurement; Measures; Medical; Medicare; Medicare claim; Mentors; Mentorship; Modeling; New England; Operative Surgical Procedures; Outcome; Outcomes Research; Patient Care; Patients; Peripheral arterial disease; Procedures; Provider; Quality of Care; Race; Reporting; Research; Research Project Grants; Risk; Role; Socioeconomic Status; Specialist; Statistical Methods; System; Testing; Time; Training; Translating; United States; Variant; Vascular Diseases; Work; base; career; career development; comparative effectiveness; cost; design; experience; health care delivery; improved; low socioeconomic status; patient population; population based; professor; regional difference; secondary outcome; shared decision making; treatment strategy

Early in my surgical training, I found the thought of having a career that affects not only clinical surgery, but also broader issues in the way health care is delivered, to be very appealing. Therefore, during surgical training, I received funding for a VA Special Fellowship in Outcomes Research to complete two years of training in health services research, and concurrently obtained a Master's Degree in Evaluative Clinical Sciences from The Dartmouth Institute (TDI). Now, as an assistant professor at Dartmouth in vascular surgery, I have some research experience, especially in the use of observational datasets to measure and predict surgical risk. However, I believe that this Award will help me to grow and achieve important short and long-term goals in building a lifelong research career. First, in terms of short term goals, this Award will expand my ability to measure the effects of variation in treatment in patients with lower extremity peripheral arterial disease (PAD). Second, my long term goal is to become a leader in vascular outcomes research, with a focus on designing clinical pathways and health policy aimed at helping patients make the best treatment choices. The ultimate goal of my research career will be to ensure that patients with vascular disease are well informed about the risks and benefits of different treatment strategies, so that they can make well-informed treatment choices. Three key elements of my career development plan will foster my efforts towards achieving these goals. First, through coursework in advanced observational statistical methods, I will ensure that I strengthen my ability to perform high-quality comparative effectiveness studies of competing treatments and strategies in lower extremity PAD. Second, through coursework in cost analysis, I will develop new expertise in cost measurement in health care. And third, I will use project-based learning to ensure that the didactic elements of my career development plan translate into action. For three reasons, TDI represents an ideal environment to pursue my research agenda. First, for over 20 years, TDI has been recognized as a national leader in studying health care delivery and effectiveness. TDI has produced national leaders in the evaluation of regional variation in the delivery and quality of care, outcomes analysis, and shared-decision-making. Second, I am fortunate to have the mentorship of one of TDI's leaders, Dr. Elliott Fisher. He has served as a mentor since my time as a VA Outcomes Fellow in 2002, continually through our recent efforts in measuring regional variation. And, third, TDI has developed a close relationship with the Vascular Study Group of New England, a regional quality improvement initiative centered at the Section of Vascular Surgery at Dartmouth. The VSGNE has served as a platform for piloting our work in linking clinical datasets to administrative data, as well as refining and testing our administrative prediction models with clinical data. My research project will examine the effect of variation in vascular treatment intensity on PAD-specific outcomes. Lower extremity peripheral arterial disease (PAD) affects over 12 million Americans, and results in nearly 100,000 major amputations (above or below-knee) annually in the United States. However, the risk of amputation from PAD varies ten-fold, depending on where patients reside. Research in the Dartmouth Atlas of Health Care has attributed some of these regional differences in amputation to patient-level factors, reporting five-fold higher amputation rates among blacks and those of low socioeconomic status (SES). However, such significant variation in amputation rates cannot be explained solely by patient factors; health care delivery to these patients varies significantly as well. Our preliminary work shows sizeable disparities in the intensity of vascular care received by patients in the year before they undergo major lower extremity amputation. These differences suggest that in some regions, far too little vascular care is being provided. In other regions, very intensive vascular care, with aggressive use of invasive revascularization procedures, may not necessarily translate into better outcomes for patients. Efforts to improve vascular care for patients with PAD will require better knowledge of the variation in intensity of care and its relationship to PAD-specific outcomes. In this proposal, I will characterize variation in the treatment of lower extremity PAD, explore the determinants of this variation, and study the relationship of intensity of vascular care to PAD-related outcomes. This project will inform my future research, aimed at better targeting the use of vascular care to achieve optimal outcomes in patients with lower extremity PAD.

在我接受外科培训的早期，我发现自己的职业不仅会影响临床手术，还会影响医疗保健提供方式等更广泛的问题，这种想法非常有吸引力。因此，在外科培训期间，我获得了VA成果研究特别奖学金的资助，完成了两年的卫生服务研究培训，并同时获得了达特茅斯学院（TDI）的评估临床科学硕士学位。现在，作为达特茅斯大学血管外科的助理教授，我有一些研究经验，特别是在使用观察数据集来测量和预测手术风险方面。然而，我相信这个奖项将帮助我成长并实现重要的短期和长期目标，以建立终身的研究生涯。首先，就短期目标而言，该奖项将扩大我测量下肢外周动脉疾病（PAD）患者治疗变化效果的能力。其次，我的长期目标是成为血管预后研究的领导者，重点是设计临床途径和健康政策，旨在帮助患者做出最佳治疗选择。我研究生涯的最终目标将是确保血管疾病患者充分了解不同治疗策略的风险和益处，以便他们能够做出明智的治疗选择。