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

• 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
• 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

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：大卫洪水，医学博士，理学硕士，是一个普通内科医生和奖学金培训的卫生服务研究员， 密歇根大学和危地马拉的中美洲和巴拿马营养研究所（INCAP）。 博士洪水的长期职业目标是成为一个独立的物理学家，科学家谁使用的专业知识， 实施研究，以改进预防、 治疗和控制心脏代谢疾病（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：药理学和行为学 干预措施可有效改善心脏代谢疾病的结果。然而，有限的执行 这些干预措施在低收入和中等收入国家（LMICs）导致发病率大幅上升， mortality.初级卫生保健中心血管疾病管理的心脏技术包是 世界卫生组织建议的解决这一实施差距的模式（“HEARTS”： 健康生活方式咨询，循证方案，获得药物，基于风险的护理，任务分担， 系统监控）。尽管有令人信服的支持证据，心脏还没有实施， 大多数中低收入国家。培训计划：为了实现研究独立性，Flood博士需要在以下方面接受额外培训：（1） 应用实施研究方法，（2）以人为本的干预设计，（3）混合 方法临床试验设计与评价。弗拉德博士将由一位杰出的跨国公司 团队包括共同小学导师Michele Heisler博士（密歇根大学）和Manuel Ramírez-Zea博士 （INCAP），他们在实施慢性病干预措施方面具有丰富的指导经验和专业知识。 他的共同导师将是Gretchen Piatt博士（实施研究）。洪博士的顾问将包括博士。 Sanjay Saint（共识设计方法），Mark霍夫曼（在全球和美国之间翻译研究） 环境），Vilma Rizzola（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博士将进行详细的研究， 在危地马拉这一单一国家实施HEARTS，可作为一个可推广的实施 供其他中低收入国家使用的模板。该研究计划将建立和扩大正在进行的NHLBI资助的 危地马拉高血压实施研究（其中共同主要导师Ramírez-Zea博士是共同PI）。 Flood博士将采用分步方法（1）确定扩大正在进行的项目的障碍和促进因素 危地马拉的高血压干预措施也包括糖尿病和血脂异常治疗， （2）共同设计一个综合治疗心脏代谢疾病的提供模式， 以人为本的设计，以及（3）评估的可行性和可接受的交付模式，使用 一项整群随机化初步研究的混合方法评价。该奖项的发现将使Flood博士 提交R 01申请，以评估2型混合试验的有效性和实施结果。