INTEGRATING PALLIATIVE CARE WITH DISEASE MANAGEMENT TO IMPROVE OUTCOMES AMONG PATIENTS WITH ADVANCED HEART FAILURE: INTERVENTIONAL RESEARCH CAREER DEVELOPMENT
将姑息治疗与疾病管理相结合,改善晚期心力衰竭患者的预后:介入研究职业发展
基本信息
- 批准号:9325061
- 负责人:
- 金额:$ 13.18万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2016
- 资助国家:美国
- 起止时间:2016-08-01 至 2020-05-31
- 项目状态:已结题
- 来源:
- 关键词:Academic Medical CentersAddressAdministratorAdvance Care PlanningAffectAmericanAntsAwardBehavior TherapyCapitalCardiacCardiologyCardiopulmonaryCardiovascular systemCaregiversCaringCertificationChronicClinicClinicalClinical ManagementClinical Oncology Supplement (K12)Clinical ResearchClinical SciencesCommunitiesComplexConsultDataDecision MakingDevelopmentDevelopment PlansDisease ManagementDoctor of PhilosophyEligibility DeterminationEmotionalEnsureEnvironmentEpidemicEthicsEvaluationEvidence based treatmentFamilyFeedbackFellowshipFoundationsFundingGoalsHealthHealth Care ResearchHealth ServicesHealthcareHealthcare SystemsHeart DiseasesHeart failureHospitalsImpairmentIndividualInpatientsInstitutesInternal MedicineInterventionIntervention StudiesIntervention TrialInterviewK-Series Research Career ProgramsLeadLeadershipLearningMeasuresMedicalMedical ResearchMedical centerMedicineMentorsMentorshipMethodsMissionNational Heart, Lung, and Blood InstituteNursesOffice NursingOutcomeOutcome StudyOutcomes ResearchOutpatientsPalliative CarePalliative MedicineParticipantPatient-Centered NursingPatientsPhasePopulationPragmatic clinical trialPreparationProcessProviderPsychosocial Assessment and CarePublic HealthQuality of lifeRandomizedRandomized Controlled TrialsRecommendationRecruitment ActivityResearchResearch PersonnelResourcesSECTM1 geneScienceSocietiesSourceSpecialistStressStructureSymptomsSystemTestingTimeTrainingTranslational ResearchTreatment FailureUniversitiesWorkbasecareercareer developmentchronic care modelclinically relevantcollaborative carecollaborative trialcomparative effectivenesscompare effectivenesscostdata formatdesigneffectiveness researchevidence baseexperiencefrailtyhealth care qualityimplementation scienceimprovedimproved outcomeinnovationmedical schoolsmedical specialtiesmultiple chronic conditionsnovelpalliativepatient orientedphysical symptomprofessorprogramspsychologicpsychological symptompsychosocialresearch and developmentskillssymptom managementtheoriestherapy developmenttreatment as usual
项目摘要
PROJECT SUMMARY/ABSTRACT
Candidate. The purpose of this K01 mentored career development award is to support Dionysios Kavaliera-
tos, Ph.D. in establishing a clinical research program that will improve patient, caregiver, and systems out-
comes in advanced heart failure (HF) through the delivery of palliative care. His long-term goal is to become an
independent health services researcher conducting patient-centered comparative effectiveness research to im-
prove quality of life for individuals affected by serious cardiopulmonary illness. Through this K01, his short-
term goal is to learn how to design and evaluate scalable and widely disseminable interventions to integrate
palliative care principles into standard cardiac management of advanced HF. Specifically, Dr. Kavalieratos will
strengthen his research expertise by way of four interrelated career development objectives: (1) to deepen his
understanding of the clinical management of patients with HF and the state-of-the-science regarding palliative
care interventions in HF; (2) to develop expertise in designing, conducting, and evaluating complex behavioral
interventions; (3) to learn dissemination and implementation science theory and methods; and (4) to develop
practical skills in the management, leadership, and ethics involved in clinical research.
Mentoring and Environment. Supporting Dr. Kavalieratos's career development experience is an inten-
tionally-designed mentoring team composed of renowned clinicians and researchers who have an outstanding
track record of mentoring junior investigators. His Primary Mentors are: Robert M. Arnold, MD FAAHPM (ex-
pertise: palliative care) and Bruce L. Rollman, MD MPH (comparative effectiveness trials of collaborative care
interventions). His Secondary Mentors are: Marie Bakitas, DNSc FAAN (nurse-led palliative care interven-
tions) and Jeffrey Teuteberg, MD (advanced HF). In addition, Dr. Kavalieratos has assembled a Career Adviso-
ry Committee to evaluate his progress towards career independence, comprising: Larry A. Allen, MD (cardio-
vascular outcomes research), David Bekelman, MD MPH (palliative care interventions in HF), and Morris
Weinberger, PhD (pragmatic clinical trials). As an Assistant Professor of Medicine within the University of
Pittsburgh's Division of General Internal Medicine, Dr. Kavalieratos will have full access to the resources, facili-
ties, and institutional capital of the School of Medicine, its Clinical and Translational Science Institute, and the
University of Pittsburgh Medical Center. The Division has a strong record of developing successful independent
investigators; more than 30 of its investigators have held or do hold individual career development awards.
Research.
Background: Over 6 million Americans live with the physical, psychosocial, and healthcare burdens of HF.
Palliative care, when provided by a palliative care specialist, has been demonstrated to alleviate many of these
burdens. Unfortunately, the specialty palliative care workforce is so severely limited that specialty palliative
care is neither a feasible or scalable strategy to meet the needs of a growing HF population. As such, there is a
critical need for innovative solutions to integrate palliative care into standard HF management, particularly for
patients receiving care outside of major academic medical centers. This proposal focuses on “primary palliative
care,” defined as basic palliative care delivered by clinicians without palliative care specialty training.
Specific Aims: First, we will develop a patient-centered, nurse-led primary palliative care intervention for
patients with advanced HF in outpatient cardiology clinics. With formative data generated in Dr. Kavalieratos's
K12 award, we will develop a structured intervention using the Medical Research Council's Framework for De-
velopment and Evaluation of RCTs for Complex Interventions. Second, we will conduct a pilot randomized con-
trolled trial (RCT) of the intervention versus usual care to assess feasibility and fidelity. This intervention,
based on the Chronic Care Model, will partner with an existing cardiology clinic nurse to deliver primary pallia-
tive care, targeting the challenges and outcomes important to patients with HF and their caregivers. We will
randomize 50 individuals with NYHA Class III/IV HF to the intervention or usual care. Third, we will refine
the intervention by exploring its acceptability, barriers, facilitators, and mechanisms of action among patients,
caregivers, and clinicians. Using the RE-AIM framework of intervention impact, we will conduct a rigorous
mixed-methods evaluation of the intervention in preparation for a fully-powered comparative effectiveness tri-
al. To ensure that this work is impactful, feasible, and sustainable, we have assembled an advisory board of
patients, caregivers, clinicians, and administrators to provide input on all phases of this project, from interven-
tion development through interpretation of results. The proposed research will provide Dr. Kavalieratos with
the preliminary data, training, and experience to develop and lead a fully-powered R01-level pragmatic RCT to
compare the effectiveness of primary palliative care versus usual HF care in patients with advanced HF be-
ing cared for in community cardiology clinics. In turn, this award will contribute to Dr. Kavalieratos's devel-
opment as a leader within the cardiopulmonary outcomes research community as he will develop, test, then
deploy clinically-relevant, patient-centered strategies to promote the provision of palliative care, thereby im-
proving patient, caregiver, and systems outcomes.
项目摘要/摘要
候选人。本次K01职业发展导师奖旨在支持狄奥尼西奥斯·卡瓦列拉--
ToS,博士,建立一个临床研究计划,将改善患者,护理者和系统-
通过提供姑息治疗来治疗晚期心力衰竭(HF)。他的长期目标是成为一名
独立的卫生服务研究人员进行以患者为中心的比较有效性研究,以促进
证明受严重心肺疾病影响的个人的生活质量。通过这个K01,他的短片-
学期目标是学习如何设计和评估可扩展且可广泛传播的干预措施,以整合
将姑息治疗原则纳入晚期心力衰竭的标准心脏管理。具体地说,卡瓦列拉托斯博士将
通过四个相互关联的职业发展目标来加强他的研究专长:(1)深化他的
对心衰患者临床处理及姑息性治疗研究现状的认识
心衰的护理干预;(2)培养设计、实施和评估复杂行为的专业知识
干预措施;(3)学习传播和实施科学的理论和方法;(4)发展
在临床研究的管理、领导和道德方面的实际技能。
指导和环境。支持卡瓦列拉托斯博士的职业发展经验是一种内在的-
精心设计的指导团队,由著名的临床医生和研究人员组成,他们拥有杰出的
指导初级调查员的记录。他的主要导师是:罗伯特·M·阿诺德,医学博士FAAHPM(前
PERITE:姑息护理)和布鲁斯·L·罗尔曼,医学硕士公共卫生硕士(协作护理的比较有效性试验
干预)。他的二级导师是:DNSSC FAAN的Marie Bakitas(护士主导的姑息治疗干预-
以及Jeffrey Teuteberg医学博士(高级心力衰竭)。此外,卡瓦列拉托斯博士还组织了一份职业顾问--
RY委员会评估他在职业独立方面的进展,成员包括:拉里·A·艾伦,医学博士(心脏
血管结果研究)、David Bekelman、MD MPH(心衰姑息治疗干预)和莫里斯
Weinberger博士(实用临床试验)。作为加州大学的医学助理教授
匹兹堡普通内科科卡瓦列拉托斯医生将完全访问资源,设施-
医学院、其临床和转化科学研究所以及
匹兹堡大学医学中心。该司在开发成功的独立
调查人员;它的调查人员中有30多人持有或确实持有个人职业发展奖。
研究。
背景:超过600万美国人生活在心力衰竭的生理、心理和医疗负担中。
姑息治疗,当由姑息治疗专家提供时,已经被证明可以缓解许多这种情况
负担。不幸的是,专门的姑息治疗劳动力非常有限,以至于专门的姑息治疗
CARE既不是一个可行的战略,也不是一个可扩展的战略,以满足日益增长的心力衰竭人口的需求。因此,有一个
迫切需要创新的解决方案,将姑息治疗纳入标准的心力衰竭管理,特别是
在主要学术医疗中心以外接受治疗的患者。这项提议的重点是“主要的姑息疗法”
护理“是指临床医生在没有经过姑息治疗专业培训的情况下提供的基本的姑息治疗。
具体目标:首先,我们将开发以患者为中心、护士为主导的初级姑息治疗干预措施
心脏病门诊中的晚期心力衰竭患者。在Kavalieratos博士的
K12奖,我们将使用医学研究理事会的去...
针对复杂干预措施的随机对照试验的发展和评价。第二,我们将进行试点随机对照--
对干预和常规护理进行随机对照试验(RCT),以评估可行性和保真度。这种干预,
基于慢性护理模式,将与现有的心脏病诊所护士合作,提供初级苍白-
预防性护理,针对对心力衰竭患者及其照顾者重要的挑战和结果。我们会
随机选择50名患有NYHA III/IV级心衰的患者接受干预或常规护理。三是精细化
通过探索其在患者中的可接受性、障碍、促进者和作用机制来进行干预,
护理员和临床医生。利用RE-AIM框架的干预影响,我们将进行严格的
干预措施的混合方法评价,以准备一个完全有效的比较效果。
艾尔为了确保这项工作有效、可行和可持续,我们成立了一个顾问委员会,由
患者、护理人员、临床医生和管理人员就该项目的所有阶段提供意见,包括
通过对结果的解释来发展。拟议的研究将为卡瓦列拉托斯博士提供
开发和领导一个功能齐全的R01级务实RCT的初步数据、培训和经验
晚期心力衰竭患者首次姑息治疗与常规治疗的疗效比较
ING在社区心脏病诊所接受护理。反过来,这一奖项将有助于卡瓦列拉托斯博士的发展-
作为心肺结果研究界的领导者,他将开发、测试
采取与临床相关的、以患者为中心的战略,促进提供姑息治疗,从而促进
证明耐心、护理者和系统的结果。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Dionysios Kavalieratos其他文献
Dionysios Kavalieratos的其他文献
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{{ truncateString('Dionysios Kavalieratos', 18)}}的其他基金
INTEGRATING PALLIATIVE CARE WITH DISEASE MANAGEMENT TO IMPROVE OUTCOMES AMONG PATIENTS WITH ADVANCED HEART FAILURE: INTERVENTIONAL RESEARCH CAREER DEVELOPMENT
将姑息治疗与疾病管理相结合,改善晚期心力衰竭患者的预后:介入研究职业发展
- 批准号:
9162916 - 财政年份:2016
- 资助金额:
$ 13.18万 - 项目类别:
INTEGRATING PALLIATIVE CARE WITH DISEASE MANAGEMENT TO IMPROVE OUTCOMES AMONG PATIENTS WITH ADVANCED HEART FAILURE: INTERVENTIONAL RESEARCH CAREER DEVELOPMENT
将姑息治疗与疾病管理相结合,改善晚期心力衰竭患者的预后:介入研究职业发展
- 批准号:
10331448 - 财政年份:2016
- 资助金额:
$ 13.18万 - 项目类别:
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