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 晕厥是一种复杂的表现症状，需要仔细和有效的评估 确定病人失去意识的病因。晕厥的患病率已有报道 高达41%，晕厥复发率为13.5%。一种常见症状，大约1%到3% 所有急诊科就诊(急诊科就诊次数与房颤一样多)，占所有医院的6% 入院是因为晕厥。晕厥患者的预后取决于病因和 潜在的心血管疾病。晕厥的心脏病因与显著更高的发病率相关 发病率和死亡率高于其他原因，如血管迷走神经反射或直立性低血压。这个 弗雷明翰的一项研究证明，患有心源性晕厥的参与者的死亡风险增加了一倍 与非心源性晕厥者比较。值得注意的是，晕厥会影响患者的生活质量。 (QOL)，晕厥频率较高的人报告的生活质量较差，总体体力和生活质量较低 精神健康和日常生活活动障碍。复发性晕厥患者的生活质量 在成年人中，似乎相当于严重的类风湿性关节炎和慢性下腰痛。尽管 过去25年的研究对特定病因的病理生理学有了很大的了解。 晕厥这种令人费解的症状的诊断方法仍然是困难和有效的。 仍然难以捉摸。 评估晕厥患者的主要挑战是大多数患者没有症状。 在他们发表演讲的时候。因为担心出现晕厥症状的患者有患晕厥的风险 即将发生的灾难性事件，过度使用和不适当地使用检测和住院治疗是常见的。 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，美国急诊医师学会 心脏病学(ACC)、美国心脏协会(AHA)和心脏节律学会(HRS)发布了一份指南 2017年晕厥患者的评估与处理采用标准化方法来 基于该指南的晕厥为向患者提供高价值护理提供了有效的机会 遭受这一令人痛心和潜在危险的事件。旨在更快地将指南翻译为 临床实践和改善健康，拟议的研究将确定障碍和促进者 实施循证、高价值的患者诊断和管理方法 出现晕厥症状。研究小组将开发一个多层次、多组件的实施方案 基于证据的晕厥评估和管理策略以及随后的混合性晕厥的计划 有效性--执行研究综合框架指导下的执行试验 (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