Facilitating adoption of COPD evidence-based care in outpatient settings (FACES)

描述(申请人提供)：这个K23奖项将为Cecere博士提供一个机会，以实现她的长期目标，即过渡到一名独立资助的内科科学家，专注于改善慢性肺部疾病患者的预后。拟议的项目建立在她之前的工作基础上，调查患者的健康行为和特征对COPD患者健康结果的影响，并研究提供的COPD护理的异质性。通过这个项目，Cecere博士将实现她的直接目标，即在集群和相关数据分析、定性研究方法以及设计和进行干预试验方面获得专业知识。这将通过一个综合的职业发展计划来实现，该计划包括正式的课程、高技能导师的指导以及获得实际研究经验的保护时间。环境：华盛顿大学(UW)丰富的学术环境是塞西尔博士继续培训的理想场所。威斯康星大学肺和重症监护医学临床研究培训课程以鼓励研究人员相互合作的大学环境而自豪。华盛顿大学还提供广泛的教育和研究资源，包括公共卫生和社区医学院和翻译健康科学研究所(华盛顿大学的临床和翻译科学奖(CTSA)机构)。此外，塞西尔还组建了一支指导团队，他们拥有医疗服务和质量改进干预方面的专业知识，在资助和出版方面有良好的记录，并成功地培训了早期研究人员，这些研究人员后来在主要的学术医学中心担任内科科学家。研究：在这项以患者为中心的研究建议中，Cecere博士将确定与最佳实践COPD护理相关的特定患者和提供者特征，并进行干预，以改善门诊环境中的护理提供。为了实现这一目标，她在与西雅图华盛顿大学医学中心相关的两家内科诊所确定了一组COPD患者及其提供者。塞西尔博士将：1)进行一项横断面研究，以确定患者和提供者的特征与坚持以证据为基础的COPD管理最佳实践指南有关；2)进行定性研究，以更好地了解患者和提供者的观点对为COPD患者提供推荐护理的影响；以及3)测试对提供者的多方面干预的效果，旨在改善最佳护理的交付。 采用准实验性临床试验设计，在初级保健环境中实践对COPD患者的护理。拟议的项目具有创新性，因为它通过检查干预措施的有效性来探索第二阶段(T2)和第三阶段(T3)研究之间的接口，该干预旨在将循证指南传播和实施到临床实践中，作为提高护理质量的一种手段。这项研究有可能导致更多的干预和传播研究，旨在改善日益增长的COPD患者的健康结果。这一模式也可以转化为改善其他慢性病患者的预后。

DESCRIPTION (provided by applicant): This K23 award will provide an opportunity for Dr. Cecere to achieve her long-term goal of transitioning to an independently-funded physician-scientist with a focus on improving outcomes for patients with chronic lung diseases. The proposed project builds on her previous work investigating the effects of patient health behaviors and characteristics on health outcomes for patients with COPD and studying heterogeneity in delivered COPD care. Through this project, Dr. Cecere will achieve her immediate goals of attaining expertise in clustered and correlated data analysis, qualitative research methods, and designing and conducting intervention trials. This will be accomplished through an integrated career development plan consisting of formal coursework, guidance from highly skilled mentors, and protected time to gain practical research experience. Environment: The rich academic environment at the University of Washington (UW) is an ideal place for Dr. Cecere's continued training. The UW Division of Pulmonary and Critical Care Medicine Clinical Research Training Track prides itself on a collegial environment in which investigators are encouraged to collaborate with one another. The UW also offers a broad range of educational and research resources, including the School of Public Health and Community Medicine and the Institute of Translational Health Sciences (the UW's Clinical and Translational Science Awards (CTSA) institution). In addition, Dr. Cecere has assembled a mentoring team with expertise in health delivery and quality improvement interventions, strong records of funding and publication, and success in training early-investigators who have gone on to have careers as physician-scientists at major academic medical centers. Research: In this patient-oriented research proposal, Dr. Cecere will identify specific patient and provider characteristics associated with best-practice COPD care and intervene to improve delivery of that care in the outpatient setting. To accomplish this, she has identified a cohort of COPD patients and their providers at the two internal medicine clinics associated with the University of Washington Medical Center in Seattle. Dr. Cecere will: 1) conduct a cross-sectional study to determine patient and provider characteristics associated with adherence to evidence-based best-practice guidelines for COPD management; 2) perform a qualitative study to better understand patient and provider perspectives influencing the delivery of recommended care for patients with COPD; and 3) test the efficacy of a multi-faceted intervention for providers designed to improve the delivery of best practice care to COPD patients in the primary care setting, using a quasi-experimental clinical trial design. The proposed project is innovative in that it explores the interface between Phase 2 (T2) and Phase 3 (T3) research by examining the efficacy of an intervention designed to disseminate and implement evidence-based guidelines into clinical practice as a means of improving quality of care. This study has the potential to lead to additional intervention and dissemination studies designed to improve health outcomes for the growing population of patients with COPD. This model can also be translated to improve outcomes for patients with other chronic diseases.