Novel Assessment of the Role of Surgery in Recurrent Diverticulitis

手术在复发性憩室炎中作用的新评估

• 批准号: 10224821
• 负责人: Alexander Tharrington Hawkins
• 金额: $ 14.96万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224821
• 关键词: Absenteeism; Accounting; Acute; Address; Affect; Age; Agreement; Ambulatory Care; American; Award; Benefits and Risks; Benign; Cessation of life; Chronic; Chronic Disease; Clinic; Clinic Visits; Cohort Studies; Colectomy; Colon and Rectal Surgeon; Colorectal; Comparative Effectiveness Research; Cost of Illness; Data; Decision Making; Development; Development Plans; Disease; Diverticulitis; Diverticulosis; Economics; Education; Emergency department visit; Environment; Equipoise; Evidence based practice; Excision; Funding; Future; Goals; Guidelines; Health Services Research; Health system; Hospitalization; Hospitals; Incidence; Information Systems; Instruction; Interview; K-Series Research Career Programs; Knowledge; Lead; Measurement; Measures; Medical Care Costs; Mentors; Mentorship; Methodology; Morbidity - disease rate; Natural History; Office Visits; Operative Surgical Procedures; Outcomes Research; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Perforation; Peritonitis; Persons; Pharmaceutical Preparations; Physicians; Population; Population Study; Procedures; Process; Public Health; Qualitative Methods; Quality of life; Quality-of-Life Assessment; Recommendation; Recovery; Recurrence; Research; Risk; Role; Schools; Sigmoid colon; Societies; Structure; Supervision; Surgeon; Surgical Management; Surveys; Techniques; Time; Training; United States; United States Agency for Healthcare Research and Quality; Universities; Visit; Work; arm; care outcomes; career development; cohort; comparative effectiveness; comparative effectiveness analysis; comparative effectiveness study; comparative effectiveness trial; cost; design; expectation; experience; financial toxicity; health care service utilization; improved; indexing; innovation; instrument; longitudinal analysis; mortality; multidisciplinary; novel; patient expectation; programs; prospective; shared decision making; surgery outcome; symposium; wound

PROJECT SUMMARY/ABSTRACT Diverticulosis of the sigmoid colon is a significant burden to the US health system. Complications lead to substantial morbidity and mortality. In 2004, diverticular disease was responsible for 313,000 hospitalizations, 1.9 million ambulatory care visits, and 3365 deaths in the United States. Indications for surgical management of chronic or recurrent diverticulitis are poorly understood. A number of studies have revealed that there is minimal mortality benefit to elective surgery for diverticular disease. Because of this, traditional surgical outcomes, such as 30-day survival, wound morbidity and in hospital complications are poor metrics to analyze this problem. This proposal describes a career development plan for a colorectal surgeon that will enable me to use my 75% protected effort to develop expertise in qualitative analysis, patient reported outcomes, comparative effectiveness, and analysis of longitudinal data. The research specific aims are: 1) to investigate alignment between the goals and expectations of patients and surgeons; 2) analyze the effect of surgery on the function and quality of life of patients with recurrent diverticulitis; and 3) assess the effect of surgery on health care utilization, work absenteeism and financial toxicity in recurrent diverticulitis. The career development plan integrates: a) advanced coursework and individualized mentor-directed instruction in qualitative methodology, patient reported outcomes, and surgical comparative effectiveness techniques, b) participation in local/national seminars and conferences to advance expertise in qualitative and quantitative aspects in development of patient reported outcomes, c) a multidisciplinary mentored research experience, and d) a highly supportive research environment. This environment includes the Center for Health Services Research, the Center for Surgical Quality and Outcomes Research, an AHRQ-funded Evidence- based Practice Center, a top-ranked Peabody School of Education, a Masters in Public Health program, and the Vanderbilt University Department of Surgery. Overall, this career development award will advance my ability in qualitative methods, patient reported outcomes and comparative effectiveness research by providing both didactic and experiential education under the supervision of proven mentors. We will generate important data on functional and quality of life outcomes for patients with diverticular disease. Importantly, this award provides critical support to seamlessly transition toward future independently funded studies that use patient reported outcomes to conduct comparative effectiveness studies to better understand the role of surgery in chronic disease states, including both diverticular disease and other disorders.

项目总结/摘要 乙状结肠憩室病是美国卫生系统的一个重大负担。并发症导联 发病率和死亡率都很高。2004年，憩室病造成313，000人死亡， 住院治疗，190万次门诊治疗，3365例死亡。适应症 对慢性或复发性憩室炎外科治疗知之甚少。 许多研究表明，选择性手术对死亡率的好处很小， 憩室病正因为如此，传统的手术结果，如30天的生存，伤口 发病率和住院并发症是分析该问题的不良指标。 本提案描述了一个结直肠外科医生的职业发展计划，使我能够使用 我75%的保护努力，以发展定性分析，病人报告的结果，比较 有效性和纵向数据分析。本研究的具体目的是：1）研究对齐 2）分析手术对功能的影响 复发性憩室炎患者的生活质量; 3）评估手术对健康护理的影响 复发性憩室炎中的药物利用、工作缺勤和经济毒性。 职业发展计划包括：a）高级课程和个性化的导师指导 定性方法、患者报告结局和手术比较有效性的说明 技术，B）参加地方/国家研讨会和会议， 患者报告结果发展的定量方面，c）多学科指导研究 （1）具有良好的科研环境。这种环境包括卫生中心 服务研究，手术质量和结果研究中心，一个AHRQ资助的证据- 的实践中心，排名第一的皮博迪教育学院，公共卫生硕士课程， 范德比尔特大学外科系。 总的来说，这个职业发展奖将提高我在定性方法方面的能力，病人报告说 成果和比较有效性研究，通过提供教学和体验教育， 有经验丰富的导师指导我们将生成关于功能和生活质量结果的重要数据 对于患有憩室病的患者。重要的是，该奖项为无缝过渡提供了关键支持 未来独立资助的研究，使用患者报告的结果进行比较 有效性研究，以更好地了解手术在慢性疾病状态中的作用，包括 憩室疾病和其他疾病。