Shared Decision-Making to Improve the Health Status of Patients with Claudication: Developing and Implementing Strategies to Individualize Treatment Decisions

共同决策以改善跛行患者的健康状况：制定和实施个性化治疗决策的策略

• 批准号: 10453459
• 负责人: Eric Alexander Secemsky
• 金额: $ 16.99万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10453459
• 关键词: Address; Advisory Committees; Affect; African American; Aftercare; American; Applications Grants; Arteries; Award; Belief; Benefits and Risks; Biometry; Biostatistical Methods; Blood Vessels; Cardiology; Cardiovascular system; Caring; Classification; Clinic; Clinical; Clinical Investigator; Clinical Research; Conflict (Psychology); Consultations; Data; Decision Aid; Decision Making; Development; Elements; Ensure; Environment; Evaluation; Evidence based treatment; Exercise; Face; Future; Goals; Health Care Costs; Health Expenditures; Health Status; Hemorrhage; Heterogeneity; Individual; Intervention; Interview; Kidney Failure; Knowledge; Lead; Leg; Location; Lower Extremity; Measurement; Measures; Medical; Medicine; Mental Depression; Mentors; Mentorship; Methods; Modeling; Multicenter Trials; Nurse Administrator; Outcome; Outcomes Research; Outpatients; Pain; Patient Care; Patient Outcomes Assessments; Patient Preferences; Patient-Focused Outcomes; Patients; Peripheral; Peripheral arterial disease; Physicians; Pilot Projects; Predictive Factor; Procedures; Process; Program Development; Provider; Qualitative Methods; Qualitative Research; Quality of Care; Quality of life; Questionnaires; Race; Readiness; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Science; Scientist; Selection for Treatments; Structure; Supervision; Symptoms; Therapeutic; Treatment outcome; Uncertainty; Woman; Work; care outcomes; career; career development; claudication; clinical care; clinical practice; comparison intervention; cost; design; diagnostic tool; experience; health care service utilization; implementation science; implementation strategy; improved; individual patient; individualized medicine; intervention cost; medical specialties; men; novel; pilot test; practice setting; pragmatic implementation; preference; prospective; response; shared decision making; skills; statistics; symptomatic improvement; tool; treatment as usual; treatment choice; treatment strategy

PROJECT SUMMARY/ABSTRACT Peripheral artery disease (PAD) affects up to 12 million Americans and accounts for healthcare expenditures totaling $21 billion annually. Invasive procedures, one of multiple therapies available to improve PAD symptoms, are increasingly being used, but are costly, may cause complications, and do not benefit all patients equally. Furthermore, selecting a PAD treatment strategy requires aligning patient preferences with the risks and benefits of therapies available to them. However, PAD care is fragmented across clinical settings and specialties, resulting in variable approaches in eliciting patient preferences and presenting treatment choices. These combined factors make implementation of shared decision-making in PAD care an urgent yet challenging endeavor. This proposal seeks to address this issue using a multi-faceted approach. In Aim 1, we will use prospective patient-level data to build and rigorously validate models that prognosticate 1- year health status and estimate responses to different therapeutic strategies (medical therapy, supervised exercise and vascular intervention). These tools will be used to individualize treatment with a focus on outcomes that are meaningful to the patient. In Aim 2, we will conduct semi-structured interviews and use a formative diagnostic tool to evaluate vascular stakeholders' beliefs, concerns, and challenges related to shared decision-making. These interviews will then be used to design practical implementation strategies. In Aim 3, we will perform a pilot study of 50 patients with claudication to evaluate the impact of an established PAD decision aid on measures of decision quality and knowledge. This study will provide preliminary data for a larger, multicenter trial evaluating how the aid can be applied to improve decision-making, health status, and long-term outcomes for patients with claudication. The overarching goal of this proposal is to promote informed, evidence-based treatment decisions among patients with claudication in order to improve quality of care and outcomes, and reduce healthcare utilization and costs. The first two aims of the proposal will provide the necessary evidence and resources to introduce shared decision-making into the vascular clinic. The third aim will evaluate the direct influence of a decision aid specific to PAD on the quality of treatment decisions. This research will be accomplished in the setting of a comprehensive career development program designed to provide Dr. Secemsky, an early career investigator and interventional cardiologist, with the skills needed to become an independent physician-scientist. His long-term career goal is to ensure that cardiovascular patients who face important medical decisions are meaningfully engaged, well informed, and receive treatments that match their preferences and goals. Over the course of the award period, Dr. Secemsky will be guided in his transition to independence by an outstanding mentoring team and advisory committee of established clinical investigators with expertise in cardiovascular medicine, outcomes research, advanced biostatistical and qualitative methods, shared decision-making, and implementation science.

项目总结/摘要 外周动脉疾病（PAD）影响多达1200万美国人，并占医疗保健支出 每年总计210亿美元。有创手术，可用于改善PAD的多种疗法之一 症状，越来越多地被使用，但成本高昂，可能导致并发症，并不能使所有人受益 患者平等。此外，选择PAD治疗策略需要将患者偏好与 他们可以获得的治疗的风险和益处。然而，PAD护理在临床上是分散的， 设置和专业，导致在不同的方法，在引发病人的喜好和介绍 治疗选择。这些综合因素使得在PAD护理中实施共同决策， 紧迫而富有挑战性的奋进。这项建议旨在采用多方面的办法解决这一问题。在 目标1，我们将使用前瞻性患者水平的数据来构建和严格验证模型， 年的健康状况和估计反应不同的治疗策略（药物治疗，监督 运动和血管介入）。这些工具将用于个性化治疗，重点是 对患者有意义的结果。在目标2中，我们将进行半结构化面试，并使用 形成性诊断工具，用于评价血管利益相关者的信念、担忧和挑战， 共同决策。然后将利用这些访谈来设计切实可行的执行战略。在 目的3，我们将对50例跛行患者进行一项初步研究，以评估一种已建立的 关于决策质量和知识措施的PAD决策辅助。本研究将提供初步数据， 一个更大的，多中心的试验，评估如何援助可以应用于改善决策，健康状况， 和跛行患者的长期结局。该提案的总体目标是促进 在跛行患者中做出知情的、循证的治疗决策，以提高 护理和结果，并降低医疗保健利用率和成本。该提案的前两个目标将 提供必要的证据和资源，将共同决策引入血管临床。 第三个目标是评估PAD特定决策辅助对治疗质量的直接影响 决策本研究将在建立一个全面的职业发展计划中完成 旨在为早期职业研究者和介入心脏病学家Secemsky博士提供以下技能： 需要成为一名独立的物理学家和科学家。他的长期职业目标是确保 面临重要医疗决策的心血管患者有意义地参与，消息灵通， 接受符合他们偏好和目标的治疗。于授出期内，博士。 塞切姆斯基将在一个优秀的指导团队和顾问的指导下向独立过渡 具有心血管医学、结局研究、 先进的生物统计和定性方法、共同决策和实施科学。