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

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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.