Implementation research for comprehensive cardiometabolic care in Guatemala

危地马拉综合心脏代谢护理的实施研究

基本信息

批准号：
10522823
负责人：
David Clifford Flood
金额：
$ 19.36万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10522823
关键词：
Address Adoption Antihypertensive Agents Award Behavior Therapy Belize Cardiometabolic Disease Cardiovascular Diseases Caring Central America Central American Cessation of life Chronic Chronic Disease Clinical Clinical Trials Consensus Costa Rica Counseling Country Developing Countries Diabetes Mellitus Disease Disease Management Disease Outcome Dyslipidemias Educational workshop El Salvador Elements Evaluation Evidence based intervention Evidence based treatment Fellowship Floods Funding Glucose Goals Guatemala Guatemalan Health Health Personnel Health Services Health system Heart Heart failure Honduras Hypertension Income Institutes Internist Intervention Intervention Studies Interview Investments Knowledge Latin America Medicine Mentors Mentorship Metabolic Diseases Methodology Methods Michigan Modeling Monitor Morbidity - disease rate Myocardial Ischemia National Heart, Lung, and Blood Institute Nicaragua Outcome Panama Participant Patients Pharmacology Physicians Pilot Projects Positioning Attribute Prevention Primary Health Care Protocols documentation Public Health Randomized Research Research Methodology Research Personnel Research Training Resources Risk Saints Sampling Scientist Strategic vision Stroke Structure System Training Translating Universities World Health Organization Zea acceptability and feasibility base cardiometabolism care delivery career career development cost effective design effective intervention effectiveness evaluation effectiveness outcome evidence base experience health training healthy lifestyle human centered design hybrid type 2 trial hypertension treatment implementation barriers implementation intervention implementation outcomes implementation research implementation study improved improved outcome low and middle-income countries member mortality multi-component intervention multidisciplinary nutrition primary outcome public health relevance research clinical testing research study skills therapy design training opportunity

项目摘要

PROJECT SUMMARY Candidate: David Flood, MD, MSc, is a general internist and fellowship-trained health services researcher at the University of Michigan and the Institute of Nutrition of Central America and Panama (INCAP) in Guatemala. Dr. Flood’s long-term career goal is to become an independent physician-scientist who uses expertise in implementation research to improve the adoption of evidence-based interventions for the prevention, treatment, and control of cardiometabolic diseases (e.g., hypertension, diabetes, and dyslipidemia) in resource-limited health systems in the U.S. and globally. Background: Pharmacologic and behavioral interventions are effective in improving cardiometabolic disease outcomes. However, limited implementation of these interventions in low- and middle-income countries (LMICs) leads to substantial excess morbidity and mortality. The Hearts Technical Package for Cardiovascular Disease Management in Primary Health Care is the model recommended by the World Health Organization to address this implementation gap (“HEARTS”: Healthy lifestyle counseling, Evidence-based protocols, Access to medicines, Risk-based care, Task sharing, and Systems monitoring). Despite compelling supporting evidence, HEARTS has not been implemented in most LMICs. Training Plan: To achieve research independence, Dr. Flood requires additional training in (1) applying implementation research methods, (2) human-centered design of interventions, and (3) mixed methods design and evaluation of clinical trials. Dr. Flood will be mentored by an outstanding, multinational team including Co-Primary Mentors Dr. Michele Heisler (University of Michigan) and Dr. Manuel Ramírez-Zea (INCAP) who have extensive mentoring experience and expertise implementing chronic disease interventions. His Co-Mentor will be Dr. Gretchen Piatt (implementation research). Dr. Flood’s advisors will include Drs. Sanjay Saint (consensus design methods), Mark Huffman (translating research between global and U.S. settings), Vilma Irazola (implementation research in Latin America), and Timothy Guetterman (mixed methods). Research Plan: With guidance from his mentors and advisors, Dr. Flood will carry out a detailed study of HEARTS implementation in a single country, Guatemala, which can serve as a generalizable implementation template for use in other LMICs. The research plan will build and expand on an ongoing NHLBI-funded hypertension implementation study in Guatemala (of which Co-Primary Mentor Dr. Ramírez-Zea is Co-PI). Using a stepwise approach, Dr. Flood will (1) identify barriers and facilitators to expanding an ongoing hypertension intervention in Guatemala to also include diabetes and dyslipidemia treatment, as recommended in WHO Hearts; (2) co-design a delivery model of integrated treatment of cardiometabolic diseases using human-centered design, and (3) evaluating the feasibility and acceptability of the delivery model using a mixed-methods evaluation of a cluster randomized pilot study. Findings from this award will position Dr. Flood to submit an R01 application to evaluate effectiveness and implementation outcomes in a type 2 hybrid trial.

项目摘要候选人：医学博士大卫·弗林（David Flood 密歇根大学和危地马拉的中美洲和巴拿马营养研究所（INCAP）。 Flood博士的长期职业目标是成为一名独立的身体科学家，他使用专业知识实施研究以改善采用基于证据的干预措施以进行预防，心脏代谢疾病的治疗和控制（例如，高血压，糖尿病和血脂异常）美国和全球资源有限的卫生系统。背景：药理和行为干预措施可有效改善心脏代谢疾病预后。但是，有限的实施这些在低收入和中等收入国家（LMIC）中的干预措施导致大量超过发病率和死亡。心血管疾病管理的心脏技术包装是初级卫生保健中的世界卫生组织推荐的模型以解决这一实施差距（“ Hearts”：健康的生活方式咨询，基于证据的协议，获得药物的访问，基于风险的护理，任务共享，和系统监视）。尽管有令人信服的支持证据，但尚未在大多数LMIC。培训计划：为了实现研究独立性，洪水博士需要在（1）中进行额外的培训应用实施研究方法，（2）以人为中心的干预设计和（3）混合方法设计和评估临床试验。洪水博士将由杰出的跨国公司考虑包括联合主导的团队Michele Heisler博士（密歇根大学）和ManuelRamírez-Zea博士（Incap）具有丰富的心理经验和实施慢性疾病干预措施的专业知识。他的院长将是Gretchen Piatt博士（实施研究）。 Flood博士的顾问将包括Drs。 Sanjay Saint（共识设计方法），Mark Huffman（全球和美国之间的研究设置），Vilma Irazola（拉丁美洲的实施研究）和Timothy Guetterman（混合方法）。研究计划：在他的导师和顾问的指导下，Flood博士将对危地马拉的一个国家的心脏实施，可以作为可推广的实施用于其他LMIC的模板。该研究计划将建立和扩展由持续的NHLBI资助危地马拉的高血压实施研究（其中共同主要导师Ramírez-Zea是Co-Pi）。洪水博士使用逐步的方法（1）确定障碍和促进者，以扩大持续的危地马拉的高血压干预也包括糖尿病和血脂异常治疗在谁心中；（2）共同设计使用综合治疗心脏代谢疾病的递送模型以人为中心的设计，以及（3）使用聚类随机试验研究的混合方法评估。该奖项的调查结果将使洪水博士定位提交R01申请以评估2型混合试验中的有效性和实施结果。