Implementing a Community-Engaged Amputation Prevention Intervention in Rural Patients with Diabetes and Peripheral Arterial Disease

对农村糖尿病和周围动脉疾病患者实施社区参与的截肢预防干预措施

• 批准号: 10189242
• 负责人: Samantha D Minc
• 金额: $ 18.83万
• 依托单位: WEST VIRGINIA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10189242
• 关键词: Achievement; Address; Amputation; Area; Award; Blood Vessels; Cardiovascular Diseases; Clinic; Clinic Visits; Clinical Investigator; Clinical Sciences; Collaborations; Communities; Community Outreach; Complications of Diabetes Mellitus; Consolidated Framework for Implementation Research; Country; County; Data; Diabetes Mellitus; Diabetic Foot; Education; Effectiveness of Interventions; Event; Evidence based intervention; Foot Ulcer; Foundations; Funding; Future; Geographic Locations; Geography; Goals; Guidelines; Health; Hotlines; Institutes; Intervention; K-Series Research Career Programs; Knowledge; Limb structure; Location; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Operative Surgical Procedures; Outcome; Patients; Pattern; Peripheral arterial disease; Practice Guidelines; Preparation; Prevalence; Provider; Quality of Care; Recommendation; Research; Research Personnel; Risk; Risk Factors; Rural; Rural Community; Rural Health; Rural Population; Self Efficacy; Societies; Specialist; Surgeon; Testing; Time; Training; Translating; Translational Research; Translations; Vascular Diseases; Wait Time; West Virginia; Work; acceptability and feasibility; barrier to care; base; care coordination; career; career development; community engagement; cultural competence; design; disease disparity; effectiveness study; foot; health disparity; high risk; implementation intervention; implementation research; improved; innovation; multidisciplinary; patient population; preservation; prevent; preventive intervention; randomized trial; research data dissemination; rural area; rural patients; skills; skills training; therapy design

Amputation is a devastating but preventable complication of diabetes (DM) and peripheral arterial disease (PAD); it serves as a marker for severe cardiovascular disease and for disparities in quality of care. Although rural populations have multiple risk factors for amputation, there is a critical gap in amputation research in rural communities, with very little data available on amputation prevention interventions designed to meet the needs of these communities to improve health outcomes. West Virginia (WV), a highly rural state with some of the highest national prevalence rates of DM and cardiovascular disease, is a location in great need of innovative solutions to prevent these complications. My long-term career goal is to become a clinician-investigator in health disparities research focused on designing and implementing community-engaged interventions that will reduce amputation rates in patients with DM and PAD. My preliminary work in this area demonstrated that DM and PAD-related amputation rates in WV are up to 6 times higher than the national average. Moreover, despite adjusting for multiple risk factors, the risk of amputation is clustered in certain high-risk geographic regions in WV. This Mentored Career Development Training Award (K23) is the ideal opportunity for me to obtain the skills, training and mentorship needed to achieve this goal. The objective of this study is to develop, implement and assess an amputation prevention intervention designed for use in high-risk rural areas using community engagement approaches. I will test the central hypothesis that an amputation prevention intervention developed and implemented in a community-engaged fashion will be feasible and acceptable for use in high-risk rural areas. The specific aims of this study are to: 1) develop a provider-based amputation prevention intervention appropriate for high-risk rural areas using community engagement approaches, 2) implement and assess the feasibility and acceptability of the collaboratively-developed, provider-based amputation prevention intervention using the Consolidated Framework for Implementation Research (CFIR) and refine the intervention based on these findings, and 3) translate and disseminate findings to community Stakeholders, and then widely to other high-risk rural areas to prepare for implementation of a multi-area intervention effectiveness study. Guided by a strong multidisciplinary mentorship team and an active Community Engagement and Outreach Core with an established Provider-Based Research Network through the WV Clinical and Translational Science Institute, I am poised to successful conduct this research plan in rural WV. The training and research plan for this K23 award will enable me to achieve my long-term career goal, to become a leader in vascular surgery with both expertise in limb preservation and designing and implementing community-engaged interventions to address vascular disease-related health disparities.

截肢是糖尿病 (DM) 和外周动脉疾病的一种毁灭性但可预防的并发症 （软垫）;它是严重心血管疾病和护理质量差异的标志。 尽管农村人口存在多种截肢危险因素，但截肢仍存在重大差距 农村社区的研究，关于截肢预防干预措施的数据很少 旨在满足这些社区改善健康状况的需求。西弗吉尼亚州 (WV) 高度农村化的州，是全国糖尿病和心血管疾病患病率最高的州之一， 是一个非常需要创新解决方案来预防这些并发症的地方。我的长期职业生涯 目标是成为健康差异研究的临床研究者，专注于设计和 实施社区参与的干预措施，以降低糖尿病患者的截肢率 和垫。我在这一领域的初步工作表明，与 DM 和 PAD 相关的截肢率 WV 比全国平均水平高出 6 倍。此外，尽管针对多重风险进行了调整 由于多种因素的影响，截肢风险集中在西弗吉尼亚州的某些高风险地理区域。本次辅导 职业发展培训奖（K23）是我获得技能、培训和知识的理想机会 实现这一目标需要指导。本研究的目的是开发、实施和评估 旨在利用社区在高风险农村地区使用的截肢预防干预措施 参与方法。我将检验截肢预防干预的中心假设 以社区参与的方式制定和实施将是可行的并且可以接受 高风险农村地区。本研究的具体目标是：1）开发基于提供者的截肢术 采用社区参与方法，适合高风险农村地区的预防干预措施， 2) 实施并评估协作开发的、基于提供商的方案的可行性和可接受性 使用实施研究综合框架进行截肢预防干预 (CFIR) 并根据这些发现完善干预措施，以及 3) 将发现转化并传播给 社区利益相关者，然后广泛到其他高风险农村地区，为实施 多领域干预效果研究。在强大的多学科导师团队的指导下 积极的社区参与和外展核心以及已建立的基于提供商的研究 通过西弗吉尼亚州临床和转化科学研究所的网络，我准备成功进行 这项研究计划在西弗吉尼亚州农村地区进行。此次 K23 奖项的培训和研究计划将使我能够 实现我的长期职业目标，成为血管外科领域的领导者，同时兼具肢体专业知识 保存以及设计和实施社区参与的干预措施以解决血管问题 与疾病相关的健康差异。