DISPLACE: Dissemination and Implementation of Stroke Prevention Looking at the Care Environment

DISPLACE：从护理环境来看中风预防的传播和实施

• 批准号: 9925881
• 负责人: ROBERT J ADAMS
• 金额: $ 101.54万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925881
• 关键词: Adoption; Affect; Age; Assessment tool; Brain Infarction; Caregivers; Caring; Child; Childhood; Chronic; Clinical; Clinical Data; Clinical Trials; Clinical Trials Design; Collaborations; Common Data Element; Communities; Complication; Comprehensive Health Care; Computerized Medical Record; Custom; Data; Defect; Development; Dictionary; Disease; Doppler Ultrasound; Education; Educational Materials; Effectiveness; Eligibility Determination; Enrollment; Ensure; Environment; Erythrocytes; Evaluation; Face; Focus Groups; Funding; Future; Generations; Geographic Distribution; Goals; Guidelines; Health; Healthcare; Hematological Disease; Hematology; Hemoglobin; Individual; Information Technology; Inherited; Institution; Intervention; Interview; Ischemic Stroke; Knowledge; Lead; Leadership; Measures; Medical; Methods; Minority; Modeling; Morbidity - disease rate; Multi-Institutional Clinical Trial; Multicenter Studies; National Heart, Lung, and Blood Institute; Outcome; Patient Education; Patient-Focused Outcomes; Patients; Population; Prevention; Prevention Guidelines; Prevention Protocols; Prevention trial; Private Sector; Protocols documentation; Provider; Randomized; Randomized Clinical Trials; Readiness; Recommendation; Research; Research Design; Risk; Sampling; Services; Sickle Cell Anemia; Site; Socioeconomic Factors; South Carolina; Specialist; Specific qualifier value; Standardization; Stroke; Stroke prevention; Surveys; System; Third-Party Payer; Time; Transfusion; United States; Universities; Vascular Endothelium; base; cohort; compare effectiveness; data management; design; evidence base; evidence based guidelines; health disparity; high risk; hydroxyurea; implementation science; implementation strategy; improved; mortality; multidisciplinary; novel; patient population; patient screening; pediatric patients; screening; social media; stroke risk; treatment strategy; web site

Project Abstract Ischemic stroke is a potentially preventable, devastating complication of sickle cell disease (SCD), a group of inherited blood disorders that affect close to 100,000 individuals in the United States. Without intervention, stroke may occur in up to 24% of individuals with the highest risk form of SCD, sickle cell anemia. Despite improvements in comprehensive care and management of SCD in children, stroke remains a major cause of morbidity and mortality due to insufficient screening and prevention practices. Individuals living with SCD continue to face multiple health disparities cause by racial and socioeconomic factors as well as disease- specific disparities in funding and private sector support. In order to standardize and improve care, the National Heart, Lung, and Blood Institute (NHLBI) released evidence-based guidelines in 2014. These guidelines established routine transcranial Doppler ultrasound (TCD) screening as a means for identifying children at high risk of stroke and indefinite chronic red cell transfusions (CRCT) as a means of treating children at high risk for stroke based on the previous NHLBI funded, randomized controlled STOP (Stroke Prevention Trial in Sickle Cell Disease) results. This proposal, entitled DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) is a multi-site effort focused on enhancing the implementation and dissemination of these evidence-based stroke prevention guidelines in SCD. The research approach is guided by the Interactive Systems Framework for Dissemination and Implementation and the multilevel ecological model of health. The DISPLACE leadership core at the Medical University of South Carolina is a multidisciplinary team lead by Dr. Julie Kanter, Dr. Robert Adams and Dr. Cathy Melvin and includes specialists in multicenter clinical trial design, hematology, implementation science, qualitative analysis and statistical evaluation. The Data Coordinating Unit (DCU) at MUSC who have coordinated over 40 multicenter studies and will provide study design and information technology support and data management support the leadership core. The aims of DISPLACE are to: 1) assess the gap between current and guideline- recommended practices for stroke prevention among pediatric patients with SCD, 2) assess the multi-level patient, provider, and systems barriers and enablers to performing TCD screening and initiating CRCT, and 3) evaluate the effectiveness of a novel multi-level dissemination and implementation strategy to increase current annual TCD screening rates and CRCT initiation rates using a parallel cluster-randomized clinical trial. We have assembled a large, multi-institutional collaboration of institutions with widespread geographic distribution to best assess the feasibility and utility of the multi-level implementation strategy. The long-term goal of DISPLACE is to ensure that all children with SCD receive guideline-based care for stroke prevention for a “stroke free generation” in SCD.

项目摘要 缺血性卒中是镰状细胞病（SCD）的一种潜在可预防的毁灭性并发症， 遗传性血液疾病影响了美国近10万人。如果不进行干预， 中风可能发生在患有最高风险形式的SCD（镰状细胞性贫血）的个体中的高达24%。尽管 随着儿童SCD综合护理和管理的改善，卒中仍然是儿童SCD的主要原因。 由于筛查和预防措施不足而导致的发病率和死亡率。SCD患者 继续面临种族和社会经济因素以及疾病造成的多种健康差距， 资金和私营部门支助方面的具体差距。为了规范和改善护理， 心肺血液研究所（NHLBI）于2014年发布了循证指南。这些准则 建立了常规经颅多普勒超声（TCD）筛查，作为识别高血压儿童的手段。 中风风险和无限期慢性红细胞输血（CRCT）作为治疗高风险儿童的一种手段， 基于先前NHLBI资助的随机对照STOP（镰状细胞卒中预防试验） 细胞疾病）结果。这项名为DISPLACE（脑卒中的传播和实施）的提案 预防-关注护理环境）是一项多地点的工作，重点是加强 并在SCD中传播这些循证卒中预防指南。研究方法是 在传播和实施互动系统框架和多层次 健康生态模式。南卡罗来纳州医科大学的DISPLACE领导核心是一个 由朱莉·坎特博士、罗伯特亚当斯博士和凯茜·梅尔文博士领导的多学科团队，包括 多中心临床试验设计、血液学、实施科学、定性分析和 统计评价MUSC的数据协调单位（DCU）协调了40多个多中心 研究，并将提供研究设计和信息技术支持和数据管理支持， 领导核心。DISPLACE的目标是：1）评估当前和指南之间的差距- 在SCD儿童患者中预防卒中的推荐实践，2）评估多水平 患者、提供者和系统进行TCD筛查和启动CRCT的障碍和推动因素，以及3） 评估一个新的多层次传播和实施战略的有效性，以增加目前的 使用平行分组随机临床试验的年度TCD筛查率和CRCT启动率。我们 已经聚集了一个大的，多机构的合作机构与广泛的地理分布 以最佳方式评估多层次执行战略的可行性和效用。的长期目标 DISPLACE旨在确保所有患有SCD的儿童在一年内接受基于指南的中风预防护理 SCD中的“无卒中生成”。