Improving management of cardiovascular medications during hospitalization

描述（由申请人提供）：在加州大学旧金山分校的10年里，我开发了一个独立的项目，专注于三个主要的兴趣领域：1)了解如何最好地安排护理系统来提高医疗保健的质量和结果，例如心脏病专家或医院医生如何影响充血性心力衰竭患者的结果；2)了解如何在非心脏手术中改善-受体阻滞剂的使用，以降低心脏发病率；3)提高我们衡量医疗质量和有效实施变革的能力。我的工作特别强调对正在进行重大非心脏手术的心血管疾病患者的管理，作为这些问题的范例。在5年的K24奖励期间，我的目标是进一步发展我的研究计划和指导研究人员，他们将对这些领域充满热情，并将成为成功的独立研究人员。为了实现这一5年目标，K24有两个具体目标：(1)开展以患者为导向的研究，旨在了解非心脏手术住院治疗如何导致心脏药物的空白，以及这些空白如何影响患者的预后。我将使用地方和国家的数据来了解心血管药物（例如，冠状动脉疾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）在非心脏手术患者中遗漏或减少的频率，以及这些药物的不连续性如何影响患者的预后。(2)建立指导计划，促进以患者为导向的研究人员的发展，这些研究人员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，包括更加重视心血管专家、医院医生和对质量改进（或将证据转化为实践）研究感兴趣的亚专家的发展，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.