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: 10686102
• 负责人: David Clifford Flood
• 金额: $ 19.05万
• 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/10686102
• 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; 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; Physicians; Pilot Projects; Positioning Attribute; Prevention; Primary Care; Primary Health Care; Protocols documentation; Public Health; Randomized; Recommendation; Research; Research Methodology; Research Personnel; Resources; Risk; Saints; Sampling; Scientist; Strategic vision; Stroke; Structure; System; Training; Translating; Universities; World Health Organization; Zea; acceptability and feasibility; 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; pharmacologic; 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.

项目概要 候选人：David Flood，医学博士、理学硕士，是一名普通内科医生和接受过专科培训的卫生服务研究员 密歇根大学和危地马拉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医师科学家，利用其专业知识 实施研究，以改进基于证据的预防干预措施的采用， 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，实施有限 低收入和中等收入国家（LMIC）的这些干预措施导致发病率大幅过高， 死亡。初级卫生保健中心血管疾病管理的 Hearts 技术包是 世界卫生组织推荐的解决这一实施差距的模型（“HEARTS”： 健康生活方式咨询、循证方案、药物获取、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，HEARTS 尚未在 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 (1) 方面接受额外培训 应用实施研究方法，(2) 以人为本的干预设计，以及 (3) 混合 临床试验的方法设计和评价。 Flood 博士将得到一位杰出的跨国公司的指导 团队包括联合主要导师 Michele Heisler 博士（密歇根大学）和 Manuel Ramírez-Zea 博士 (INCAP) 拥有丰富的指导经验和实施慢性病干预措施的专业知识。 他的联合导师是 Gretchen Piatt 博士（实施研究）。弗拉德博士的顾问将包括博士。 Sanjay Saint（共识设计方法）、Mark Huffman（翻译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：在导师和顾问的指导下，Flood博士将进行详细的研究 HEARTS 在单个国家（危地马拉）的实施，可以作为通用实施 用于其他中低收入国家的模板。该研究计划将建立并扩展 NHLBI 资助的一项正在进行的研究 危地马拉高血压实施研究（其中联合主要导师 Ramírez-Zea 博士是联合 PI）。 Flood 博士将采用逐步的方法 (1) 找出扩大持续发展的障碍和促进因素。 根据建议，危地马拉的高血压干预措施还包括糖尿病和血脂异常治疗 在世界卫生组织的心中； (2) 共同设计心脏代谢疾病综合治疗的实施模式 以人为本的设计，以及（3）使用以下方法评估交付模型的可行性和可接受性： 整群随机试点研究的混合方法评估。该奖项的调查结果将为弗拉德博士定位 提交 R01 申请以评估 2 类混合试验的有效性和实施结果。

项目成果

The triglyceride glucose index and cardiovascular disease outcomes.

• DOI: 10.1016/s2666-7568(22)00269-0
• 发表时间: 2023-01
• 期刊: LANCET HEALTHY LONGEVITY
• 影响因子: 13.1
• 作者: Flood, David;Brant, Luisa Campos Caldeira;Sussman, Jeremy B
• 通讯作者: Sussman, Jeremy B

Prevalence of diabetes among Indigenous women in Guatemala: A retrospective chart review study of 13 643 patients between 2015-2022.

危地马拉土著妇女糖尿病患病率：2015 年至 2022 年期间对 13 643 名患者进行的回顾性图表审查研究。

• DOI: 10.1101/2024.01.08.24300932
• 发表时间: 2024
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Alajajian,Stephen;Bartolimin,Jenny;Martin,YolandaJuarez;Scott,Caitlin;Rohloff,Peter;Flood,David
• 通讯作者: Flood,David

Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories.

• DOI: 10.1371/journal.pgph.0002768
• 发表时间: 2024
• 期刊: PLOS global public health