Improving management of cardiovascular medications during hospitalization

描述(申请人提供)：在我担任加州大学旧金山分校教员的10年中，我开发了一个独立的项目，专注于三个主要感兴趣的领域：1)了解如何最好地安排护理系统以提高医疗保健的质量和结果，例如心脏科医生或住院医生可能如何影响充血性心力衰竭患者的预后；2)了解如何改进β-受体阻滞剂在非心脏手术中的使用，以降低心脏发病率；以及3)提高我们衡量医疗保健质量并有效实施变化的能力。我的工作特别强调心血管疾病患者的管理，这些患者正在接受重大的非心脏手术，作为这些问题的范例。在5年的K24获奖期内，我的目标是进一步发展我的研究计划，并指导那些对这些领域充满热情的调查人员，他们将成为成功的独立调查人员。为了实现这一5年目标，K24有两个具体目标：(1)进行以患者为导向的研究，旨在了解非心脏手术住院如何在心脏药物方面产生缺口，以及这些缺口如何影响患者的预后。我将使用当地和全国的数据来了解非心脏手术患者错过或放弃心血管药物(例如，冠心病患者使用阿司匹林，或充血性心力衰竭患者使用血管紧张素转换酶抑制剂)的频率，以及这些药物的中断如何影响患者的预后。(2)创建导师计划，促进以患者为导向的研究人员的发展，他们对提高心血管疾病患者的护理质量感兴趣。我将指导研究员和初级教员，并使我的指导组合多样化，将更多的重点放在心血管专家、住院医生和对质量改进(或将证据转化为实践)研究感兴趣的小组专家的发展上，作为他们的职业目标。

DESCRIPTION (provided by applicant): In the 10 years I have been on the UCSF faculty, I have developed an independent program focused on three major areas of interest: 1) Understanding how care systems might be best arranged to improve both quality and outcomes of healthcare, such as how cardiologists or hospitalists might affect outcomes of patients with congestive heart failure; 2) Understanding how improve use of beta-blockers in noncardiac surgery as a way to reduce cardiac morbidity, and 3) Improving our ability to measure the quality of healthcare and implement change effectively. My work has placed a particular emphasis on the management of patients with cardiovascular illness who are undergoing major noncardiac surgery as a paradigm for these questions. Over the 5-year K24 award period, my goals are to further develop my research program and mentor investigators who will be passionate about these same areas, and who will become successful independent investigators. To achieve this 5 year goal, this K24 has 2 specific aims: (1) to perform patient-oriented research aimed at understanding how hospitalization for noncardiac surgery produces gaps in cardiac medications and how these gaps affect patient outcomes. I will use local and national data to understand how often cardiovascular medications (for example, use of aspirin in patients with coronary artery disease, or angiotensin-converting enzyme inhibitors in patients with congestive heart failure) are missed or dropped in noncardiac surgery patients, and how discontinuity in these medications impacts patient outcomes. (2) To create a mentorship program that will foster the development of patient-oriented researchers interested in improving the quality of care for patients with cardiovascular disease. I will mentor fellows and junior faculty, and diversify my mentorship portfolio to include a greater emphasis on the development of cardiovascular specialists, hospitalists, and subspecialists who have an interest in quality-improvement (or, translating evidence into practice) research as their career goal.