Evaluating Implementation of Comprehensive Assessment and Telemedicine Consultation to Prevent Amputations for Patients with Lower Extremity Ulcers in Rural Health Clinics.

评价农村卫生诊所下肢溃疡患者预防截肢综合评估和远程医疗会诊的实施情况。

• 批准号: 9891085
• 负责人: Misty Dawn Humphries
• 金额: $ 15.74万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9891085
• 关键词: Accident and Emergency department; Adoption; Affect; American; Amputation; Ankle; Area; Blood flow; Caring; Center for Translational Science Activities; Childhood; Chronic Disease; Cities; Classification; Clinic; Clinical Sciences; Competence; Computers; Consultations; Custom; Data; Databases; Diabetes Mellitus; Distant; Educational process of instructing; Emergency department visit; Ensure; Environment; Evaluation; Evidence based treatment; Foot Ulcer; Frequencies; Future; Goals; Grant; Guidelines; Health; Health Policy; Health Technology; Hospitalization; Infection; Informatics; Intensive Care; Intervention; Ischemia; Leg; Leg Ulcer; Limb structure; Measurement; Measures; Mentored Patient-Oriented Research Career Development Award; Methods; Nature; Operative Surgical Procedures; Outcome; Outpatients; Patient Care; Patient Education; Patient risk; Patient-Focused Outcomes; Patients; Perfusion; Peripheral arterial disease; Persons; Pilot Projects; Play; Policy Research; Procedures; Provider; Quality of Care; Randomized; Research; Research Personnel; Resources; Risk; Role; Rural; Rural Health Centers; Sample Size; Scheme; Specialist; Staging; Surveys; System; Telemedicine; Telephone; Test Result; Testing; Time; Training; Ulcer; United States; United States National Institutes of Health; Work; base; care costs; care providers; clinical practice; evidence based guidelines; experience; foot; implementation science; improved; improved outcome; indexing; insight; medical specialties; meetings; member; patient oriented; prevent; primary outcome; programs; rural area; rural patients; skills; surgery outcome; tool; urban area; wound; wound healing

Project Summary/ Abstract $25 billion is spent annually to care for patients with lower extremity ulcers due to peripheral artery disease (PAD) and Diabetes Mellitus (DM) in the United States. Despite this over 185,000 patients with PAD, DM, or combined PAD/DM undergo leg amputation with a risk of 55% for amputation of the opposite leg. In rural patients the risk is 50% higher compared to urban areas. Guidelines for treating lower extremity ulcers are founded on objective evaluation of arterial perfusion with ankle brachial index (ABI) testing and characterization of the ulcer using a validated classification system (WIfI). Barriers to implementation of both include poor dissemination among primary providers, questions of how to implement tools within a busy clinical practice, and limited access to subsequent treatment. Adoption of telemedicine to manage patients with lower extremity ulcers has been low; however, we believe that the use of telemedicine in addition to dissemination and implementation of evidence based guidelines can improve timing of care and may reduce hospitalizations, emergency room visits, and amputations. My long-term goal is to decrease preventable amputations for patients with foot ulcers due to DM and/or PAD. My immediate goal is to develop my skills as an implementation science researcher with a focus on bringing evidence based guidelines to rural clinics and providing specialty care using telemedicine, and evaluating the effect of patient activation influences outcomes. The K23 award will support my time to implement ABI and WIfI use in rural clinics and to use telemedicine to improve timing of care, which may ultimately decrease hospitalizations and amputations. There are several relevant and complementary resources available to me within the environment at UC Davis. First and foremost, the NIH Clinical & Translational Science Center (CTSC) represents a substantial resource pool including grant and statistical support as well as Informatics and database support. The UC Davis Center for Healthcare and Technology (CHT), where Dr. Marcin serves as the Director of Pediatric Telemedicine, has all the resources needed to conduct specialist consultation through telemedicine already in place. Finally, the UC Davis Center for Healthcare Policy and Research (CHPR), led by Joy Melnikow, has a robust network of qualitative researchers with experience in patient centered studies as well as health policy researchers to provide methods expertise and support implementation of the project. The UC Davis Surgical Outcomes Group, of which I am a member, holds monthly meetings to discuss “research in progress”. This group will serve as a valuable tool for reviewing ideas and analytical work during my grant. Overall, without the collaborative nature at UC Davis, I would not be able to succeed in this proposal.

项目摘要/摘要 每年花250亿美元用于照顾下肢溃疡的患者，原因 美国疾病（PAD）和糖尿病（DM）。尽管有超过185,000名PAD患者，但 DM或组合的PAD/DM经历腿截肢，截肢的风险为55％。在农村 与城市地区相比，患者的风险高出50％。治疗下肢溃疡的指南是 建立在用踝臂指数（ABI）测试和表征对动脉灌注的客观评估建立 使用经过验证的分类系统（WIFI）的溃疡。实施两者的障碍包括穷人 主要提供者之间的传播，如何在繁忙的临床实践中实施工具的问题以及 有限的后续治疗机会。采用远程医疗来管理下肢患者 溃疡很低；但是，我们认为，除了传播和 实施基于证据的准则可以改善护理时间，并可以减少住院时间， 紧急房间访问和截肢。 我的长期目标是减少由于DM和/或而导致脚溃疡患者的可预防截肢 软垫。我的直接目标是发展我作为实施科学研究人员的技能，重点是 将基于证据的指南带到粗糙的诊所，并使用远程医疗提供专业护理，以及 评估患者激活的影响会影响结果。 K23奖将支持我的时间 在粗糙的诊所中实施ABI和WiFi使用，并使用远程医疗来改善护理时间，这可能 最终减少住院和截肢。 在UC的环境中，我有几种相关和完整的资源 戴维斯。首先，NIH临床与转化科学中心（CTSC）代表了实质性 资源池在内，包括赠款和统计支持以及信息学和数据库支持。加州大学戴维斯分校 医疗技术中心（CHT），马辛博士担任小儿主任 远程医疗，拥有通过远程医疗进行专业咨询所需的所有资源 地方。最后，由乔伊·梅尔尼科夫（Joy Melnikow）领导的加州大学戴维斯分校医疗保健政策与研究中心（CHPR）有一个 具有稳健的定性研究人员网络，具有以患者为中心的研究以及健康政策的经验 研究人员提供方法专业知识并支持该项目的实施。加州大学戴维斯分校手术 我是成员的成果小组举行每月会议，讨论“正在进行的研究”。这 小组将作为我赠款期间审查想法和分析工作的宝贵工具。总体而言，没有 加州大学戴维斯分校的合作性质，我将无法在该建议中取得成功。