Implementation research for comprehensive cardiometabolic care in Guatemala

项目总结 候选人：David Flood，医学博士，理学硕士，是一名普通内科医生，并接受过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)。 Flood博士的长期职业目标是成为一名独立的内科科学家，利用专业知识 开展实施研究，以改进采用循证干预措施进行预防， 治疗和控制心脏代谢性疾病(如高血压、糖尿病和血脂异常) 美国和全球资源有限的医疗体系。背景：药理学和行为学 干预措施在改善心脏代谢性疾病预后方面是有效的。然而，有限的实施 低收入和中等收入国家(LMIC)的这些干预措施导致严重的超额发病率和 死亡率。初级卫生保健中心血管疾病管理的心脏技术包是 世界卫生组织为解决这一执行差距而建议的模式(“心脏”： 健康的生活方式咨询，循证方案，获得药物，基于风险的护理，任务分担， 和系统监控)。尽管有令人信服的支持证据，但心脏尚未在 大多数LMIC。培训计划：为了实现研究独立性，Flood博士需要在(1)方面进行额外的培训 应用实施研究方法，(2)以人为中心的干预设计，(3)混合 方法设计和评价临床试验。Flood博士将得到一位杰出的跨国企业的指导 团队成员包括共同小学导师米歇尔·海斯勒博士(密歇根大学)和曼努埃尔·拉米雷斯-泽亚博士 (INCAP)具有广泛的指导经验和实施慢性病干预的专业知识。 他的共同导师将是格雷琴·皮亚特博士(实施研究)。弗洛德博士的顾问将包括弗洛德博士。 Sanjay Saint(共识设计方法)，Mark Huffman(在全球和美国之间翻译研究。 环境)、维尔玛·伊拉佐拉(拉丁美洲的实施研究)和蒂莫西·盖特曼(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 在单一国家--危地马拉--实施CHARS，这可以作为一个可推广的实施 用于其他LMIC的模板。该研究计划将在正在进行的NHLBI资助的基础上建立和扩大 危地马拉高血压实施研究(共同小学导师Ramírez-Zea博士是共同小学导师)。 使用循序渐进的方法，Flood博士将(1)确定扩展正在进行的 危地马拉的高血压干预还包括建议的糖尿病和血脂异常治疗 在世卫组织心脏；(2)共同设计心脏代谢性疾病综合治疗的交付模式，使用 以人为本的设计，以及(3)使用 整群随机先导研究的混合方法评价。这一奖项的发现将使Flood博士 提交R01申请，以评估类型2混合试验的有效性和实施结果。

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.