INTEGRATING PALLIATIVE CARE WITH DISEASE MANAGEMENT TO IMPROVE OUTCOMES AMONG PATIENTS WITH ADVANCED HEART FAILURE: INTERVENTIONAL RESEARCH CAREER DEVELOPMENT

将姑息治疗与疾病管理相结合，改善晚期心力衰竭患者的预后：介入研究职业发展

• 批准号: 9162916
• 负责人: Dionysios Kavalieratos
• 金额: $ 13.18万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9162916
• 关键词: Academic Medical Centers; Address; Administrator; Advance Care Planning; Affect; American; Ants; Award; Behavior Therapy; Capital; Cardiac; Cardiology; Cardiopulmonary; Cardiovascular system; Caregivers; Caring; Certification; Chronic; Clinic; Clinical; Clinical Management; Clinical Oncology Supplement (K12); Clinical Research; Clinical Sciences; Communities; Complex; Consult; Data; Decision Making; Development; Development Plans; Disease Management; Doctor of Philosophy; Duct (organ) structure; Eligibility Determination; Emotional; Ensure; Environment; Epidemic; Ethics; Evaluation; Evidence based treatment; Family; Feedback; Foundations; Funding; Goals; Health; Health Care Research; Health Services; Healthcare; Healthcare Systems; Heart Diseases; Heart failure; Hospitals; Individual; Inpatients; Institutes; Internal Medicine; Intervention; Intervention Studies; Intervention Trial; Interview; K-Series Research Career Programs; Lead; Leadership; Learning; Life; Measures; Medical; Medical Research; Medical center; Medicine; Mentors; Mentorship; Methods; Mission; National Heart, Lung, and Blood Institute; Nurses; Office Nursing; Outcome; Outcome Study; Outcomes Research; Outpatients; Palliative Care; Palliative Medicine; Participant; Patient-Centered Nursing; Patients; Phase; Population; Pragmatic clinical trial; Preparation; Process; Provider; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Research; Research Personnel; Resources; SECTM1 gene; Science; Shipping; Ships; Societies; Source; Specialist; Stress; Structure; Symptoms; System; Testing; Time; Training; Translational Research; Universities; Work; abstracting; base; care burden; career; career development; chronic care model; clinically relevant; collaborative care; comparative effectiveness; compare effectiveness; cost; design; effectiveness research; effectiveness trial; evidence base; experience; frailty; health care quality; implementation science; improved; improved outcome; innovation; medical schools; medical specialties; meetings; novel; palliative; patient oriented; physical symptom; professor; programs; psychologic; psychological symptom; psychosocial; research and development; skills; symptom management; theories; treatment as usual

PROJECT SUMMARY/ABSTRACT Candidate. The purpose of this K01 mentored career development award is to support Dionysios Kavaliera- tos, Ph.D. in establishing a clinical research program that will improve patient, caregiver, and systems out- comes in advanced heart failure (HF) through the delivery of palliative care. His long-term goal is to become an independent health services researcher conducting patient-centered comparative effectiveness research to im- prove quality of life for individuals affected by serious cardiopulmonary illness. Through this K01, his short- term goal is to learn how to design and evaluate scalable and widely disseminable interventions to integrate palliative care principles into standard cardiac management of advanced HF. Specifically, Dr. Kavalieratos will strengthen his research expertise by way of four interrelated career development objectives: (1) to deepen his understanding of the clinical management of patients with HF and the state-of-the-science regarding palliative care interventions in HF; (2) to develop expertise in designing, conducting, and evaluating complex behavioral interventions; (3) to learn dissemination and implementation science theory and methods; and (4) to develop practical skills in the management, leadership, and ethics involved in clinical research. Mentoring and Environment. Supporting Dr. Kavalieratos's career development experience is an inten- tionally-designed mentoring team composed of renowned clinicians and researchers who have an outstanding track record of mentoring junior investigators. His Primary Mentors are: Robert M. Arnold, MD FAAHPM (ex- pertise: palliative care) and Bruce L. Rollman, MD MPH (comparative effectiveness trials of collaborative care interventions). His Secondary Mentors are: Marie Bakitas, DNSc FAAN (nurse-led palliative care interven- tions) and Jeffrey Teuteberg, MD (advanced HF). In addition, Dr. Kavalieratos has assembled a Career Adviso- ry Committee to evaluate his progress towards career independence, comprising: Larry A. Allen, MD (cardio- vascular outcomes research), David Bekelman, MD MPH (palliative care interventions in HF), and Morris Weinberger, PhD (pragmatic clinical trials). As an Assistant Professor of Medicine within the University of Pittsburgh's Division of General Internal Medicine, Dr. Kavalieratos will have full access to the resources, facili- ties, and institutional capital of the School of Medicine, its Clinical and Translational Science Institute, and the University of Pittsburgh Medical Center. The Division has a strong record of developing successful independent investigators; more than 30 of its investigators have held or do hold individual career development awards. Research. Background: Over 6 million Americans live with the physical, psychosocial, and healthcare burdens of HF. Palliative care, when provided by a palliative care specialist, has been demonstrated to alleviate many of these burdens. Unfortunately, the specialty palliative care workforce is so severely limited that specialty palliative care is neither a feasible or scalable strategy to meet the needs of a growing HF population. As such, there is a critical need for innovative solutions to integrate palliative care into standard HF management, particularly for patients receiving care outside of major academic medical centers. This proposal focuses on “primary palliative care,” defined as basic palliative care delivered by clinicians without palliative care specialty training. Specific Aims: First, we will develop a patient-centered, nurse-led primary palliative care intervention for patients with advanced HF in outpatient cardiology clinics. With formative data generated in Dr. Kavalieratos's K12 award, we will develop a structured intervention using the Medical Research Council's Framework for De- velopment and Evaluation of RCTs for Complex Interventions. Second, we will conduct a pilot randomized con- trolled trial (RCT) of the intervention versus usual care to assess feasibility and fidelity. This intervention, based on the Chronic Care Model, will partner with an existing cardiology clinic nurse to deliver primary pallia- tive care, targeting the challenges and outcomes important to patients with HF and their caregivers. We will randomize 50 individuals with NYHA Class III/IV HF to the intervention or usual care. Third, we will refine the intervention by exploring its acceptability, barriers, facilitators, and mechanisms of action among patients, caregivers, and clinicians. Using the RE-AIM framework of intervention impact, we will conduct a rigorous mixed-methods evaluation of the intervention in preparation for a fully-powered comparative effectiveness tri- al. To ensure that this work is impactful, feasible, and sustainable, we have assembled an advisory board of patients, caregivers, clinicians, and administrators to provide input on all phases of this project, from interven- tion development through interpretation of results. The proposed research will provide Dr. Kavalieratos with the preliminary data, training, and experience to develop and lead a fully-powered R01-level pragmatic RCT to compare the effectiveness of primary palliative care versus usual HF care in patients with advanced HF be- ing cared for in community cardiology clinics. In turn, this award will contribute to Dr. Kavalieratos's devel- opment as a leader within the cardiopulmonary outcomes research community as he will develop, test, then deploy clinically-relevant, patient-centered strategies to promote the provision of palliative care, thereby im- proving patient, caregiver, and systems outcomes.

项目总结/摘要 候选人这个K 01指导职业发展奖的目的是支持Dionysios Kavaliera- tos博士在建立一个临床研究计划，将改善病人，护理人员和系统， 晚期心力衰竭（HF）患者通过提供姑息治疗。他的长期目标是成为一名 独立的卫生服务研究人员进行以病人为中心的比较有效性研究，以IM， 证明受严重心肺疾病影响的个人的生活质量。通过这个K 01，他的短- 长期目标是学习如何设计和评估可扩展和广泛传播的干预措施， 将姑息治疗原则纳入晚期HF的标准心脏管理。具体来说，卡瓦列拉托斯博士将 通过四个相互关联的职业发展目标来加强他的研究专长：（1）加深他的 了解HF患者的临床管理和姑息治疗的科学现状 HF护理干预;（2）发展设计，实施和评估复杂行为的专业知识 干预措施;（3）学习传播和实施科学理论和方法;（4）开发 在临床研究中涉及的管理，领导和伦理方面的实践技能。 指导和环境。支持Kavalieratos博士的职业发展经验是一个国际- 由著名的临床医生和研究人员组成的合理设计的指导团队， 指导初级调查员的记录他的主要导师是：罗伯特M。Arnold，MD FAAHPM（前- pertise：palliative care）和布鲁斯L. Rollman，MD MPH（协作护理的比较有效性试验） 干预）。他的二级导师是：玛丽Bakitas，DNSc FAAN（护士领导的姑息治疗干预， 和Jeffrey Teuteberg，MD（晚期HF）。此外，Kavalieratos博士还编写了一份职业建议- 一个委员会来评估他在职业独立方面的进展，包括：拉里A。艾伦，医学博士（心脏- 血管结局研究）、大卫贝克尔曼（医学博士、公共卫生硕士）（心力衰竭姑息治疗干预）和莫里斯 Weinberger，PhD（Pragmatic Clinical Trials）.作为一名医学助理教授， 匹兹堡的普通内科，博士Kavalieratos将有充分的资源，facili- 关系，以及医学院的机构资本，其临床和转化科学研究所， 匹兹堡大学医学中心。该司在发展成功的独立 调查员;其30多名调查员曾获得或确实获得个人职业发展奖。 Research. 背景：超过600万美国人生活在HF的身体，心理和医疗负担中。 由姑息治疗专家提供的姑息治疗已被证明可以缓解其中许多问题 负担不幸的是，专业姑息治疗的劳动力是如此严重的有限，专业姑息治疗 护理对于满足不断增长的HF人群的需求而言既不是可行的也不是可扩展的策略。因此，有一个 迫切需要创新的解决方案，将姑息治疗纳入标准HF管理，特别是 在主要学术医疗中心以外接受治疗的患者。这一建议的重点是“初级姑息疗法”， 姑息治疗”的定义是由未经姑息治疗专业培训的临床医生提供的基本姑息治疗。 具体目标：首先，我们将制定以患者为中心，护士为主导的初级姑息治疗干预措施， 心脏病门诊的晚期HF患者。卡瓦利耶拉托斯博士的 K12奖，我们将开发一个结构化的干预使用医学研究理事会的框架， 复杂干预的RCT的实施和评价。其次，我们将进行试点随机对照- 干预与常规护理的对照试验（RCT），以评估可行性和保真度。这次干预， 基于慢性护理模式，将与现有的心脏病诊所护士合作，提供原发性麻痹， 针对HF患者及其护理人员的重要挑战和结果。我们将 将50名NYHA III/IV级HF患者随机分配至干预组或常规护理组。第三，我们将细化 通过探索其可接受性，障碍，促进者和患者之间的作用机制， 护理人员和临床医生。使用RE-AIM干预影响框架，我们将进行严格的 混合方法评估干预措施，为充分把握的比较有效性三 al.为了确保这项工作具有影响力、可行性和可持续性，我们组建了一个咨询委员会， 患者，护理人员，临床医生和管理人员提供该项目所有阶段的输入，从干预， 通过对结果的解释来促进发展。这项拟议中的研究将为Kavalieratos博士提供 初步数据、培训和经验，以开发和领导一个全面的R 01级实用RCT， 在晚期HF患者中比较初级姑息治疗与常规HF治疗的有效性， 在社区心脏病诊所接受治疗。反过来，这个奖项将有助于博士Kavalieratos的发展- 作为心肺结果研究界的领导者，他将开发，测试，然后 部署临床相关的，以病人为中心的战略，以促进提供姑息治疗，从而提高， 证明患者、护理人员和系统的结果。