Adaptation and Implementation of Clinical Practice Guidelines to Improve Stroke Outcomes in Zambia

调整和实施临床实践指南以改善赞比亚中风结果

• 批准号: 10693267
• 负责人: DEANNA Rae Saylor
• 金额: $ 18.52万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693267
• 关键词: Achievement; Acute; Address; Admission activity; Adopted; Adult; Africa South of the Sahara; Age; Alteplase; Area; Attention; Award; Biological; Biology; Caregivers; Caring; Cause of Death; Cessation of life; Clinical Practice Guideline; Clinical Research; Collaborations; Communities; Country; Data; Dependence; Development; Enrollment; Ethnic Origin; Focus Groups; Future; Goals; Guideline Adherence; Guidelines; HIV; Health Personnel; Health system; Hospital Referrals; Hospitals; Income; Inpatients; Institutionalization; International; Intervention; Interview; Knowledge; Literature; Maps; Measures; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; Neurologic; Neurology; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Persons; Population Heterogeneity; Positioning Attribute; Prevalence; Process; Prospective cohort; Provider; Research; Research Methodology; Research Personnel; Research Training; Resources; Rheumatic Heart Disease; Risk Factors; Secondary to; Services; Southern Africa; Specialist; Standardization; Stroke; System; Systems Development; Teaching Hospitals; Training; Training Programs; Universities; Work; Working stroke; Zambia; acute stroke; care delivery; care systems; clinical care; clinical implementation; clinical practice; clinical trial implementation; clinically relevant; cohort; contextual factors; design; disability; effectiveness trial; epidemiology study; evidence base; experience; functional outcomes; global health; implementation evaluation; implementation framework; implementation process; implementation research; implementation science; improved; improved outcome; inpatient service; low and middle-income countries; medical schools; mortality; nervous system disorder; neuroimaging; observational cohort study; post intervention; primary outcome; professor; programs; secondary outcome; skills; stroke intervention; stroke outcome; stroke patient; treatment strategy; uptake; working group

PROJECT SUMMARY The goal of this K01 application is to provide an individualized program of mentored research training for Dr. Deanna Saylor, an Assistant Professor in the Department of Neurology at the Johns Hopkins University School of Medicine. Dr. Saylor has been based full-time in Zambia since 2018 where, in collaboration with local stakeholders, she has launched the first neurology inpatient unit and first neurology post-graduate training program in the country. Dr. Saylor is applying for an International Research Scientist Development Award to gain skills and experience in implementation science research. Combined with her background in clinical and epidemiological research, this new skillset will uniquely position her to both generate new knowledge and help develop care systems that effectively implement new knowledge to improve patient outcomes. The research plan outlined in this application leverages the developing system of neurological care in Zambia to understand current stroke care practices at the University Teaching Hospital (UTH; Zambia's national referral hospital), develop locally relevant stroke clinical practice guidelines, and examine the effect of their implementation on stroke outcomes. Since stroke is the second leading cause of adult disability and mortality worldwide and stroke prevalence in sub-Saharan Africa is amongst the highest in the world, these data are urgently needed to address this national, regional, and global health problem. The proposed research includes a pre-intervention prospective cohort of patients with stroke at UTH to characterize current stroke care clinical practices and stroke outcomes (aim 1). A stroke working group including relevant stakeholders will then be convened to investigate community, patient, provider, and health systems factors leading to difficulty achieving stroke quality measures and optimal outcomes. The Adopt-Contextualize-Adapt framework will then be used to develop locally relevant clinical practice guidelines from international stroke guidelines for implementation (aim 2). These guidelines will then be implemented, and a post-intervention observational cohort study conducted to examine their impact on achieving stroke quality measures and improving stroke outcomes. This K01 will also support Dr. Saylor's training goals which include gaining additional training and mentorship in the following key areas: (1) implementation science frameworks and methodology; (2) qualitative data methods and analysis; (3) stroke clinical research methods, especially aspects unique to global settings; and (4) developing an international network of collaborators for future large-scale and generalizability studies. In order to achieve these goals, Dr. Saylor has established an international team of mentors with expertise in implementation science, qualitative studies, stroke research, neurology research in sub-Saharan Africa, and stroke center development in international settings. This award will provide Dr. Saylor with the mentorship, knowledge, and experience necessary to become an independent investigator in global neurology conducting clinical and implementation research to improve outcomes for patients with stroke and other neurologic disorders.

项目摘要 这个K 01应用程序的目标是提供一个指导研究培训博士个性化计划。 约翰霍普金斯大学学院神经病学系助理教授迪安娜·塞勒说， 医学。Saylor博士自2018年以来一直在赞比亚全职工作，与当地的 她发起了第一个神经病学住院部和第一个神经病学研究生培训， 方案在国内。塞勒博士正在申请国际研究科学家发展奖， 获得实施科学研究的技能和经验。结合她的临床背景， 流行病学研究，这一新的技能将独特地定位她既产生新的知识和帮助 开发护理系统，有效地实施新知识，以改善患者的治疗效果。研究 本申请中概述的计划利用赞比亚正在发展的神经护理系统来了解 大学教学医院（UTH;赞比亚国家转诊医院）目前的中风护理实践， 制定当地相关的中风临床实践指南，并检查其实施对 中风结果。由于中风是全球成人残疾和死亡的第二大原因， 撒哈拉以南非洲的中风患病率是世界上最高的，迫切需要这些数据， 解决这个国家、地区和全球的健康问题。拟议的研究包括一个预先干预 UTH卒中患者前瞻性队列，以表征当前卒中护理临床实践， 卒中结局（目的1）。随后将召集包括相关利益相关者在内的中风工作组， 调查社区、患者、提供者和卫生系统因素导致难以实现卒中 质量措施和最佳结果。然后，将使用“适应-情境化-适应”框架来 根据国际卒中指南制定本地相关的临床实践指南（aim 2）的情况。然后将实施这些指南，并进行干预后观察性队列研究 以检查它们对实现卒中质量测量和改善卒中结局的影响。K 01将 我也支持塞勒博士的培训目标，其中包括获得以下方面的额外培训和指导 关键领域：（1）实施科学框架和方法;（2）定性数据方法， 分析;（3）中风临床研究方法，特别是全球环境独特的方面;以及（4）开发 一个国际合作者网络，用于未来的大规模和普遍性研究。为了实现 为了实现这些目标，塞勒博士建立了一个国际导师团队， 科学、定性研究、中风研究、撒哈拉以南非洲的神经病学研究和中风中心 国际环境中的发展。该奖项将为塞勒博士提供指导，知识， 成为全球神经病学独立研究者所需的经验， 实施研究，以改善中风和其他神经系统疾病患者的预后。