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Guideline to Implementation: A Rapid Clinical Care Pathway to Care for Patients Affected by Chronic Constipation

实施指南：治疗慢性便秘患者的快速临床护理途径

基本信息

批准号：
10570628
负责人：
Eric Dinesh Shah
金额：
$ 19.32万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-05-15 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10570628
关键词：
Academic Medical Centers Adoption Affect Automobile Driving Caring Chronic Chronic Care Clinic Clinical Colonoscopy Community Practice Constipation Consultations Data Devices Diagnostic Equipment Diagnostic Procedure Disease Effectiveness Electronic Health Record Endoscopy Fiber Funding Gastroenterologist Gastroenterology Gastrointestinal Motility Goals Grant Guidelines Health Health system Image Impairment Improve Access Intake Intervention Medical Multicenter Trials Needs Assessment Outpatients Pathway interactions Patient Care Patient Triage Patients Pelvic floor structure Pelvis Physical therapy Physiological Point of Care Technology Population Positioning Attribute Positive Reinforcements Practice Guidelines Prediction of Response to Therapy Process Production Provider Quality of life Questionnaires Recommendation Rectum Refractory Rehabilitation therapy Research Research Personnel Rotation Specialized Center Symptoms Technology Testing Training Treatment outcome Triage United States National Institutes of Health Visit Work behavioral economics career cell motility clinical care clinical decision support clinical practice cost design diagnostic technologies effective therapy evidence base health care delivery implementation science implementation trial improved laxative learned behavior medical specialties motility disorder novel patient population physical therapist pilot trial point of care point-of-care diagnostics practice setting prospective provider adoption provider behavior randomized trial rectal response routine care success support tools targeted treatment technology development tertiary care treatment as usual usability user centered design

项目摘要

PROJECT SUMMARY Technology development is a stated goal of the NIH. Myriad promising technologies have been developed, yet few cross the chasm to adoption. Few NIH-funded researchers are trained to develop and sustain transformative clinical care pathways that harness novel, evidence-based technologies to improve patient health. This training grant proposes to close this gap. Chronic constipation is one of the most frequent medical complaints and leads to 2 million gastroenterology referrals each year in the US. For symptomatic constipation refractory to laxatives, practice guidelines recommend physiological testing to identify anorectal evacuation disorders that preferentially respond to safe and effective pelvic rehabilitation therapy typically delivered by a physical therapist. Unfortunately, 98% of patients never undergo such testing and instead undergo unnecessary and repeated diagnostic procedures and rotating trials of ineffective and costly laxatives. This is largely because high-tech testing is limited to specialty motility centers. We recently developed and prospectively validated the ability of a simple, novel point-of-care device (RED) to predict treatment outcomes with subsequent physical therapy during the initial office consultation. We propose to develop and pilot a rapid clinical care pathway anchored on a provider-facing clinical decision support tool (INTEGRATE) to facilitate adoption of RED and transform care for chronic constipation in general gastroenterology practice. The training plan aims to prepare the applicant for a career vested in transforming healthcare delivery for patients affected by GI motility disorders by developing rapid clinical care pathways that promote targeted therapy harnessing evidence-based diagnostic technology. Targeted advanced coursework will provide training in behavioral economics, user-centered design, and implementation science to facilitate these career goals. In Research Aim 1, we will conduct a needs assessment with patient and provider co-production partners to develop our intervention to nudge providers toward using RED and to facilitate related care. In Aim 2, we will evaluate the usability of our intervention to ensure that it triggers appropriately and fits within clinical workflow. In Aim 3, we will launch our intervention in a regional gastroenterology practice to evaluate its effectiveness and implementation in practice. The project will provide the necessary preliminary data for an R01 supporting a larger, randomized trial. By the conclusion of the K23, the applicant will be positioned for academic success with a niche in creating transformative clinical care pathways harnessing diagnostic technology to pull tertiary care paradigms downstream to general care settings to improve the health of patients affected by the GI motility disorders, the most common GI disorders in practice.

项目总结