Project MISSION: Developing a multicomponent, Multilevel Implementation Strategy for Syncope OptImalCare thrOugh eNgagement

项目使命：通过参与制定晕厥优化护理的多组成部分、多层次实施策略

• 批准号: 9755244
• 负责人: Jing Li
• 金额: $ 50.94万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9755244
• 关键词: Academic Medical Centers; Accident and Emergency department; Activities of Daily Living; Adherence; Adopted; Adoption; Adult; Affect; American; American Heart Association; Assessment tool; Atrial Fibrillation; Attitude; Cardiac; Cardiology; Cardiovascular system; Caring; Characteristics; Chronic low back pain; Climate; Clinical; Clinical Practice Guideline; Collaborations; Community Hospitals; Complex; Dangerousness; Data; Diagnosis; Diagnostic; Distress; Effectiveness; Emergency Department Physician; Emergency Medicine; Emergency department visit; Etiology; Evaluation; Event; Functional disorder; Goals; Guidelines; Health; Hospitalization; Hospitals; Hybrids; Impairment; Interview; Knowledge; Mediating; Medicine; Mental Health; Morbidity - disease rate; Organizational Culture; Orthostatic Hypotension; Participant; Patient-Focused Outcomes; Patients; Perception; Population; Prevalence; Process; Provider; Public Health; Quality of life; Readiness; Recommendation; Recurrence; Reflex action; Reporting; Research; Rheumatoid Arthritis; Risk; Social Environment; Societies; Standardization; Structure; Surveys; Symptoms; Syncope; System; Testing; Time; Translations; Unconscious State; Vasovagal; Work; adverse outcome; base; clinical care; clinical practice; college; common symptom; design; evidence base; experience; heart rhythm; high risk; implementation research; implementation strategy; implementation trial; improved; mortality; mortality risk; novel; outcome forecast; physical conditioning; social organization; tool

Project Abstract Syncope is a complex presenting symptom that requires thoughtful and efficient evaluation to determine the etiology of a patient's loss of consciousness. Prevalence rates of syncope have been reported as high as 41%, with recurrent syncope occurring in 13.5%. A common symptom, approximately 1% to 3% of all emergency department (ED) visits (as many ED visits as atrial fibrillation) and up to 6% of all hospital admissions are due to syncope. The prognosis among patients with syncope depends on the etiology and underlying cardiovascular condition. A cardiac etiology of syncope is associated with significantly higher rates of morbidity and mortality than other causes such as vasovagal reflex mediated or orthostatic hypotension. The Framingham study documented a doubling of the risk of death among participants with cardiac syncope compared with those with non-cardiac syncope. Notably, experiencing syncope affects patients' quality of life (QoL), and those with more frequent syncope report poorer QoL with perceptions of low overall physical and mental health and impairment in activities of daily living. The QoL among patients with recurrent syncope appears equivalent to severe rheumatoid arthritis and chronic low-back pain in an adult population. Though research in the past 25 years provides substantial understanding of the pathophysiology of particular etiologies of syncope, the diagnostic approach to such a perplexing symptom remains difficult and efficient diagnosis remains elusive. The major challenge in the evaluation of patients with syncope is that most patients are asymptomatic at the time of their presentation. Because of concerns that patients presenting with syncope are at risk for an impending catastrophic event, overuse and inappropriate use of testing and hospital admission are common. Aiming to provide guidance on optimizing the evaluation and management of syncope, a collaboration of the American College of Emergency Physicians, Society for Academic Emergency Medicine, American College of Cardiology (ACC), American Heart Association (AHA) and Heart Rhythm Society (HRS) issued a Guideline for the Evaluation and Management of Patients with Syncope in 2017. Adopting a standardized approach to syncope based on this guideline offers an effective opportunity for delivering high value care to patients suffering this distressing and potentially dangerous event. Aiming for more rapid translation from guideline to clinical practice and improved health, the proposed study will identify barriers and facilitators for implementation of an evidence-based, high value approach to diagnosis and management of patients presenting with syncope. The research team will develop a multi-level, multi-component implementation strategy for evidence-based syncope evaluation and management and plan for a subsequent hybrid effectiveness-implementation trial, guided by the Consolidated Framework for Implementation Research (CFIR).

项目摘要 晕厥是一种复杂的临床症状，需要经过深思熟虑和有效的评估， 确定病人失去意识的病因据报道， 高达41%，其中13.5%发生反复晕厥。一种常见的症状，大约1%到3%的 所有急诊科（艾德）访视（艾德访视次数与房颤相同）和高达6%的所有医院访视 入院是因为晕厥晕厥患者的预后取决于病因和 基础心血管疾病。心源性晕厥的发生率显著高于 发病率和死亡率高于其他原因，如血管迷走神经反射介导的或直立性低血压。的 一项研究表明，心脏性晕厥患者的死亡风险增加了一倍 与非心源性晕厥患者相比。值得注意的是，晕厥会影响患者的生活质量 (QoL)，而那些更频繁晕厥的人报告的生活质量较差， 精神健康和日常生活能力受损。反复发作晕厥患者生活质量调查 在成人人群中，似乎等同于严重的类风湿性关节炎和慢性腰痛。虽然 过去25年的研究提供了对特定病因的病理生理学的实质性理解 晕厥，诊断方法，这样一个复杂的症状仍然是困难和有效的诊断 仍然难以捉摸 晕厥患者评估的主要挑战是大多数患者无症状 在他们介绍的时候。由于担心出现晕厥的患者有发生 即将发生的灾难性事件、过度使用和不适当使用检测以及住院是常见的。 旨在为优化晕厥的评估和管理提供指导， 美国急诊医师学会、学术急诊医学学会、美国 心脏病学（ACC）、美国心脏协会（AHA）和心律学会（HRS）发布了一项指南， 2017年晕厥患者的评估和管理。采用标准化方法， 基于该指南的晕厥提供了一个有效的机会，为患者提供高价值的护理 遭受这一痛苦和潜在危险的事件。旨在更快地从指南翻译为 临床实践和改善健康，拟议的研究将确定障碍和促进因素， 实施以证据为基础的高价值的患者诊断和管理方法 出现晕厥研究小组将制定一个多层次、多组件的实施方案 晕厥循证评估和管理策略及后续混合治疗计划 在实施研究综合框架的指导下进行的有效性实施试验 （CFIR）。

项目成果

Value-based syncope evaluation and management: Perspectives of health care professionals on readiness, barriers and enablers.

• DOI: 10.1016/j.ajem.2020.05.029
• 发表时间: 2020-09
• 期刊: The American journal of emergency medicine
• 作者: Li J;Gupta V;Smyth SS;Cowley A;Du G;Sirrine M;Stearley S;Chadha R;Bhalla V;Williams MV
• 通讯作者: Williams MV

Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool.

• DOI: 10.2196/25192
• 发表时间: 2021-11-16
• 期刊: Journal of medical Internet research
• 影响因子: 7.4
• 作者: Amin S;Gupta V;Du G;McMullen C;Sirrine M;Williams MV;Smyth SS;Chadha R;Stearley S;Li J
• 通讯作者: Li J

"Passing Out is a Serious Thing": Patient Expectations for Syncope Evaluation and Management.

• DOI: 10.2147/ppa.s307186
• 发表时间: 2021
• 期刊: Patient preference and adherence
• 影响因子: 2.2
• 作者: Clouser JM;Sirrine M;McMullen CA;Cowley AM;Smyth SS;Gupta V;Williams MV;Li J
• 通讯作者: Li J

Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework.

• DOI: 10.3390/medicina57060570
• 发表时间: 2021-06-03
• 期刊: Medicina (Kaunas, Lithuania)
• 作者: Li J;Smyth SS;Clouser JM;McMullen CA;Gupta V;Williams MV
• 通讯作者: Williams MV

Identifying Guideline-Practice Gaps to Optimize Evaluation and Management for Patients With Syncope.

• DOI: 10.1016/j.cjca.2020.05.022
• 发表时间: 2021-03
• 期刊: The Canadian journal of cardiology
• 作者: Smyth S;Gupta V;Williams M;Cowley A;Sirrine M;Surratt H;Chadha R;Stearley S;Bhalla V;Li J
• 通讯作者: Li J