Implanted but not forgotten: identifying and testing pragmatic strategies to improve inferior vena cava filter retrieval

植入但不被遗忘：识别和测试改善下腔静脉滤器回收的实用策略

• 批准号: 10650821
• 负责人: Premal S Trivedi
• 金额: $ 18.73万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-01
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650821
• 关键词: Address; Adoption; Adult; Anticoagulants; Blood Vessels; Blood coagulation; Cardiovascular system; Caring; Child; Clinic; Clinical; Coagulation Process; Colorado; Communities; Computerized Medical Record; Data; Dedications; Deep Vein Thrombosis; Devices; Doctor of Philosophy; Education; Educational workshop; Ensure; Environment; Excision; Fracture; Goals; Guidelines; Health; Health Services; Health system; Heart; Hospitals; Implant; Inferior vena cava structure; Informatics; Injury; Institution; Intervention; Interview; Lead; Leadership; Leg; Life; Literature; Lung; Measures; Medicare; Mentors; Mentorship; Methodology; Morbidity - disease rate; Nurses; Organ; Outcome; Outcomes Research; Patient Care; Patient-Focused Outcomes; Patients; Patterns of Care; Penetration; Physicians; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Process; Provider; Publishing; Pulmonary Embolism; Quality of Care; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Retrieval; Safety; Science; Scientist; Societies; Structure; System; Testing; Thrombosis; Time; Training; United States; Universities; Variant; Veins; Vena Cava Filters; Work; acceptability and feasibility; contextual factors; deep vein; design; effectiveness/implementation trial; electronic medical record tool; experience; follow-up; implantation; implementation framework; implementation science; improved; improved outcome; invention; migration; multidisciplinary; pilot test; pragmatic intervention; prevent; programs; radiologist; skills; therapy design; venous thromboembolism

PROJECT SUMMARY/ABSTRACT As a vascular and interventional radiologist and a health services researcher, my long-term goal is to achieve transformative improvements in vascular procedural care through national quality of care assessments and implementing pragmatic inventions to improve outcomes. This research and training proposal will allow me to gain critical skills needed to establish independence and launch a portfolio of scientific contributions focused on systems-level quality improvement in venous thromboembolism (VTE) related care. The goal of this research proposal is to increase timely retrieval of inferior vena cava filters (IVCF) and improve patient outcomes in the United States. Inferior vena cava filters are very commonly placed in patients with blood clots in the leg (deep venous thrombosis; DVT) or lungs (pulmonary embolism; PE), to prevent propagation to the heart, which can be fatal. Unfortunately, national retrieval rates remain low and prolonged IVCF implantation has resulted in considerable, avoidable morbidity. Multi-society guidelines recently emphasized the need to improve timely IVCF retrieval rates through institution of structured follow up programs and to better understand which program components are effective in real world settings. What is needed next is identification and testing of pragmatic strategies to improve timely IVCF retrieval in real-world settings. We propose to do this via three complimentary aims: 1) quantification of facility-level variation in IVCF retrieval across the United States; 2) qualitative characterization of high-performing institutions to identify best practices and characterize facilitators and barriers to their implementation; 3) design, pilot testing and iterative adaptation of a pragmatic intervention package to improve IVCF retrieval, informed by the existing literature and adapted with findings from aim 2. The pragmatic intervention will then be tested in multi-center hybrid implementation-effectiveness trials to follow, with the goal of improving timely IVCF retrieval and reducing complications across hospitals in the United States. My training aims closely parallel the proposed research methodology through focused education in: a) Bayesian hospital profiling, b) qualitative interviewing and analysis, and c) intervention design using an implementation science framework. This training will be accomplished through an intentional mix of structured coursework, formal workshop experience and one-on-one education with topical research experts. My mentorship team and research environment at the University of Colorado Denver (UCD) are ideally suited to this proposal. My primary mentor, P. Michael Ho MD PhD, is a national leader in cardiovascular quality assessment and pragmatic intervention design. I will additionally leverage the extensive data and methodologic core resources of Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS) and Data2Value (D2V) initiatives at the University of Colorado to accomplish these aims.

项目总结/摘要 作为一名血管和介入放射科医生和健康服务研究人员，我的长期目标是实现 通过国家护理质量评估实现血管手术护理的变革性改进， 实施务实的发明以改善成果。这项研究和培训计划将使我能够 获得建立独立性所需的关键技能，并推出一系列科学贡献， 静脉血栓栓塞症（VTE）相关护理的系统级质量改进。 本研究提案的目标是增加下腔静脉滤器（IVCF）的及时回收， 改善美国患者的治疗效果。下腔静脉滤器非常常见于患者体内 腿部（深静脉血栓形成; DVT）或肺部（肺栓塞; PE）有血栓， 传播到心脏这可能是致命的不幸的是，国家检索率仍然很低， IVCF植入导致了相当大的，可避免的发病率。多社会准则最近 强调需要通过建立结构化随访计划来提高IVCF的及时取出率 并且更好地理解哪些程序组件在真实的世界设置中是有效的。了新的要求和希望 识别和测试实用策略，以提高实时IVCF检索在现实世界中的设置。我们 我建议通过三个互补的目标来做到这一点：1）量化IVCF检索中的设施水平变化 2）对高绩效机构进行定性描述，以确定最佳做法 并描述其实施的促进者和障碍; 3）设计，试点测试和迭代 根据现有文献，调整实用干预包，以改善IVCF检索 并根据目标2的结果进行调整。然后，将在多中心混合实验中对务实干预进行测试。 实施有效性试验，以提高及时IVCF检索和减少 并发症在美国的医院。 我的培训目标通过以下方面的重点教育与拟议的研究方法密切相关：a） 贝叶斯医院概况，B）定性访谈和分析，以及c）使用 实施科学框架。这种培训将通过有意混合结构化的 课程作业、正式研讨会经验和专题研究专家的一对一教育。 我的导师团队和研究环境在科罗拉多丹佛大学（UCD）是理想的 适合这个提议。我的主要导师，P. Michael Ho MD PhD，是心血管领域的国家领导人 质量评估和务实的干预设计。我将进一步利用广泛的数据， 成人和儿童成果研究和交付科学联盟的方法学核心资源 （ACCORDS）和Data 2 Value（D2 V）倡议在科罗拉多大学实现这些目标。