Implementing a Community-Engaged Amputation Prevention Intervention in Rural Patients with Diabetes and Peripheral Arterial Disease

截肢是糖尿病(DM)和外周动脉疾病的一种毁灭性但可预防的并发症 (PAD)；它是严重心血管疾病和护理质量差异的标志。 尽管农村人口有多种截肢的危险因素，但截肢方面存在严重差距。 在农村社区进行研究，关于截肢预防干预的数据很少 旨在满足这些社区改善健康结果的需求。西弗吉尼亚州 该州高度农村，糖尿病和心血管疾病的患病率在全国名列前茅， 是一个非常需要创新解决方案来防止这些并发症的地方。我长期的职业生涯 目标是成为健康差距研究的临床医生和调查员，专注于设计和 实施社区参与的干预措施，降低糖尿病患者的截肢率 和Pad。我在这方面的初步工作表明，DM和PAD相关截肢率在 WV比全国平均水平高出6倍。此外，尽管对多重风险进行了调整，但 因素方面，截肢的风险集中在西弗吉尼亚州的某些高危地理区域。这位导师 职业发展培训奖(K23)是我获得技能、培训和 为了实现这一目标，需要导师的帮助。这项研究的目标是制定、实施和评估 一种针对高危农村社区的截肢预防干预措施 接洽方法。我将测试一个中心假设，即截肢预防干预 以社区参与的方式开发和实施将是可行的，并可用于 高危农村地区。本研究的具体目的是：1)开发一种基于提供者的截肢 适用于高危农村地区的预防干预措施，采用社区参与办法， 2)实施和评估协作开发的、基于提供商的 利用实施研究综合框架进行截肢预防干预 (CFIR)并根据这些调查结果改进干预措施，以及3)翻译和传播调查结果以 社区利益攸关方，然后广泛到其他高危农村地区，为实施 多地区干预效果研究。在强大的多学科指导团队的指导下 积极的社区参与和外联核心，并建立了基于提供商的研究 通过西弗吉尼亚大学临床和翻译科学研究所的网络，我准备成功地进行 本研究计划在西弗吉尼亚州农村地区开展。K23大奖的培训和研究计划将使我能够 实现我的长期职业目标，成为血管外科领域的领导者，同时拥有四肢方面的专业知识 保护和设计并实施社区参与的干预措施，以解决血管问题 与疾病相关的健康差距。

Amputation is a devastating but preventable complication of diabetes (DM) and peripheral arterial disease (PAD); it serves as a marker for severe cardiovascular disease and for disparities in quality of care. Although rural populations have multiple risk factors for amputation, there is a critical gap in amputation research in rural communities, with very little data available on amputation prevention interventions designed to meet the needs of these communities to improve health outcomes. West Virginia (WV), a highly rural state with some of the highest national prevalence rates of DM and cardiovascular disease, is a location in great need of innovative solutions to prevent these complications. My long-term career goal is to become a clinician-investigator in health disparities research focused on designing and implementing community-engaged interventions that will reduce amputation rates in patients with DM and PAD. My preliminary work in this area demonstrated that DM and PAD-related amputation rates in WV are up to 6 times higher than the national average. Moreover, despite adjusting for multiple risk factors, the risk of amputation is clustered in certain high-risk geographic regions in WV. This Mentored Career Development Training Award (K23) is the ideal opportunity for me to obtain the skills, training and mentorship needed to achieve this goal. The objective of this study is to develop, implement and assess an amputation prevention intervention designed for use in high-risk rural areas using community engagement approaches. I will test the central hypothesis that an amputation prevention intervention developed and implemented in a community-engaged fashion will be feasible and acceptable for use in high-risk rural areas. The specific aims of this study are to: 1) develop a provider-based amputation prevention intervention appropriate for high-risk rural areas using community engagement approaches, 2) implement and assess the feasibility and acceptability of the collaboratively-developed, provider-based amputation prevention intervention using the Consolidated Framework for Implementation Research (CFIR) and refine the intervention based on these findings, and 3) translate and disseminate findings to community Stakeholders, and then widely to other high-risk rural areas to prepare for implementation of a multi-area intervention effectiveness study. Guided by a strong multidisciplinary mentorship team and an active Community Engagement and Outreach Core with an established Provider-Based Research Network through the WV Clinical and Translational Science Institute, I am poised to successful conduct this research plan in rural WV. The training and research plan for this K23 award will enable me to achieve my long-term career goal, to become a leader in vascular surgery with both expertise in limb preservation and designing and implementing community-engaged interventions to address vascular disease-related health disparities.