Understanding Real-World Outcomes of Endovascular Treatment of Claudication

项目摘要/摘要 外周动脉疾病(PAD)，定义为血管狭窄，导致流向 四肢痛是一种常见的诊断，影响到近五分之一的美国人，造成超过210亿美元的损失 每年一次。跛行(行走疼痛)是PAD最常见的表现。侵入性治疗 尽管缺乏这些程序的长期有效性的证据，PAD仍迅速上升。如果没有 充分了解这些治疗的长期效果和提供者的动机 开出这些治疗处方后，决策过程仍不明朗。提供有效性的长期数据 治疗策略和提供者选择治疗的原因将直接改善患者共享的决策- 制作。 这项研究计划的目标是描述跛行干预的长期有效性。 并探索提供者做出治疗决定的动机。这项建议的三个目的是：1) 描述治疗跛行的干预措施的长期比较效果，2)措施 跛行干预措施的治疗效果的异质性，以及3)确定主要的诱因 医生通过评估提供者对药物治疗、开放手术和 血管内介入治疗。前两个目标将使用来自退伍军人健康中心的新的丰富的临床数据 用药来衡量治疗策略的相对有效性。第三个目标将雇用 半结构化访谈，以探索提供者对治疗有效性的看法和治疗动机 治疗决定。拟议的研究和培训将为奥斯本博士提供必要的技能 成为心血管疾病比较有效性研究的领导者，并加强共享 决策。 奥斯本博士的职业发展将在一个多样化的跨学科团队的指导下得到促进。 培训将包括研究生水平的高级教学课程，组织管理，行为和 理论、质的研究方法和实施科学。他将在准备中获得新的技能。 手稿和勇气。这次培训将直接导致他成为一名独立的 调查员，旨在提高PAD患者的护理质量。这个职业发展奖将 为进一步的研究提供基础，以制定减少护理变化和改善 PAD患者的治疗。

PROJECT SUMMARY/ABSTRACT Peripheral arterial disease (PAD), defined as narrowed blood vessels causing decreased blood flow to the extremities, is a common diagnosis, affecting nearly 1 in 5 Americans and costing more than $21 billion annually. Claudication (pain with walking) is the most common manifestation of PAD. The invasive treatment of PAD has risen rapidly despite a lack of evidence of the long-term effectiveness of these procedures. Without a full understanding of the long-term effectiveness of these treatments and the motivations of providers prescribing these treatments, decision-making remains unclear. Providing long-term data of the effectiveness of treatment strategies and why providers choose treatments will directly improve patient shared decision- making. The goal of this research proposal is to describe the long-term effectiveness of interventions for claudication and to explore the provider motivations for treatment decisions. The three aims of this proposal are: 1) Describe the long-term comparative effectiveness of interventions in the treatment of claudication, 2) Measure the heterogeneity of treatment effects of interventions for claudication, and 3) Identify the key motivators of physician practice by assessing provider perceptions of the effectiveness of medical therapy, open surgery and endovascular interventions. The first two aims will use novel clinically-rich data from the Veterans Health Administration to measure the comparative effectiveness of treatment strategies. The third aim will employ semi-structured interviews to explore provider perceptions of treatment effectiveness and motivations for treatment decisions. The proposed research and training will provide Dr. Osborne with the necessary skills to become a leader in comparative effectiveness research in cardiovascular disease and enhance shared decision-making. Dr. Osborne's career development will be fostered by the mentorship of a diverse interdisciplinary team. Training will include graduate level advanced didactic coursework in organizational management, behavior and theory, qualitative research methods and implementation science. He will acquire new skills in the preparation of manuscripts, and grantsmanship. This training will directly lead to his development into an independent investigator, aimed at improving the quality of care for patients with PAD. This career development award will provide the groundwork for further studies to develop strategies to decrease variation in care and improve the treatment of patients with PAD.