Improving Health Outcomes Through Enhanced Patient-Provider Relationships

项目摘要/摘要 该K23职业发展奖将支持候选人的培训和职业发展，以 培养衡量和评估患者-提供者关系的专业知识--这是治疗艺术的核心-- 以及它们对健康结果的影响。虽然这种关系会在许多不同的情况下影响症状， 我们对其影响背后的机制或如何增强它知之甚少。的快速增长 补充和综合医学(IM)可能在一定程度上是由于患者-提供者之间的质量差异 与传统医学相比，这是一种关系。在三个关键领域的培训将有助于候选人 向独立性过渡：1)自主神经生理生物标志物的测定与分析 系统活动，包括皮肤电反应(GSR)和心率变异性(HRV)；2)设计、执行、 以及定性研究的分析，重点是分析患者与提供者互动的视频；以及3) 临床试验和相关生物统计分析的设计和管理。这些培训目标将是 由1)一流的导师和顾问团队支持--Maurizio Fava医学博士(主要导师)，John Denninger，医学博士，博士(共同导师)，顾问Chin Hur，医学博士，公共卫生硕士，Ted Kaptchuk教授，Eric Macklin博士， 维塔利·纳帕多，博士，Elyse Park，博士，公共卫生硕士，彭正康博士；2)资源丰富的机构 环境；3)有针对性的高级课程、有指导的实验室经验和研究研讨会；以及 4)拟开展的研究工作。以胃食道反流病(GERD)为模型系统， 拟议的研究将寻求1)确定与GERD症状改善相关的生理反应 在增强的患者-提供者互动中，2)使用定性方法来确定访问特征 与所识别的生理反应相关联，以及3)确定增强型患者提供者 互动(类似于IM提供商访问)与同理心的传统医疗访问可以增强 奥美拉唑改善胃肠道反流病症状的先导随机对照试验。建议的结果 初步研究将对有效的患者-提供者关系背后的机制提供洞察力 R01应用程序的数据，并将有效地为专注于研究患者的职业生涯奠定基础- 提供者关系及其对健康结果的影响。虽然初步研究将集中在GERD上，但它是 预期所确定的机制将广泛适用于各种不同的健康状况和 对改善传统医疗环境中的护理质量和医疗保健培训有影响 供应商。

Project Summary / Abstract This K23 career development award will support the training and career development of the Candidate to develop expertise in measuring and evaluating patient-provider relationships – the core of the healing arts – and their effects on health outcomes. While this relationship influences symptoms in many different conditions, we know little about the mechanisms underlying its effect or how to augment it. The rapid growth of complementary and integrative medicine (IM) may, in part, be due to a qualitative difference in patient-provider relationships compared to conventional medicine. Training in three critical areas will facilitate the Candidate’s transition to independence: 1) measurement and analysis of physiologic biomarkers of autonomic nervous system activity including galvanic skin response (GSR) and heart rate variability (HRV); 2) design, execution, and analysis of qualitative research with a focus on analysis of videos of patient-provider interactions; and 3) design and management of clinical trials and relevant biostatistical analyses. These training goals will be supported by 1) a stellar team of mentors and consultants – Maurizio Fava, MD (primary mentor), John Denninger, MD, PhD (co-mentor), and consultants Chin Hur, MD, MPH, Prof.Ted Kaptchuk, Eric Macklin, PhD, Vitaly Napadow, PhD, Elyse Park, PhD, MPH, and Cheng-Kang Peng, PhD; 2) a resource-rich institutional environment; 3) targeted advanced coursework, mentored laboratory experiences, and research seminars; and 4) the proposed research studies. Using gastroesophageal reflux disease (GERD) as a model system, the proposed studies will seek to 1) identify physiologic responses associated with GERD symptom improvement in enhanced patient-provider interactions, 2) use qualitative approaches to determine the visit characteristics associated with the identified physiologic responses, and 3) determine whether enhanced patient-provider interactions (similar to an IM provider visit) vs. empathic, conventional medical visits can augment the effect of omeprazole on GERD symptom improvement in a pilot randomized controlled trial. Results of the proposed studies will provide insights into the mechanisms underlying effective patient-provider relations, preliminary data for an R01 application, and will effectively lay the foundation for a career focused on studying patient- provider relations and their effects on health outcomes. While initial studies will focus on GERD, it is anticipated that the mechanisms identified will be broadly applicable to range of different health conditions and have implications for improving quality of care in the conventional medical setting and training of healthcare providers.