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

项目摘要 技术开发是NIH的既定目标。无数有前途的技术已经开发出来，但很少有人跨越鸿沟采用。很少有NIH资助的研究人员接受过开发和维持变革性临床护理途径的培训，这些途径利用新颖的循证技术来改善患者健康。这项培训补助金旨在弥补这一差距。慢性便秘是最常见的医疗投诉之一，每年在美国导致200万胃肠病转诊。对于泻药难治的症状性便秘，实践指南建议进行生理测试，以确定肛门直肠排空障碍，优先响应通常由物理治疗师提供的安全有效的骨盆康复治疗。不幸的是，98%的患者从未接受过此类测试，而是接受不必要的重复诊断程序和无效和昂贵的泻药的轮换试验。这在很大程度上是因为高科技测试仅限于专业运动中心。我们最近开发并前瞻性验证了一种简单，新颖的床旁设备（RED）在最初的办公室咨询期间预测后续物理治疗的治疗结果的能力。我们建议开发和试点一个快速的临床护理路径，锚定在一个面向供应商的临床决策支持工具（INTEGRATE），以促进采用RED和改造护理慢性便秘在一般胃肠病学实践。该培训计划旨在通过开发快速临床护理途径，促进利用循证诊断技术的靶向治疗，为受胃肠道动力障碍影响的患者提供医疗保健服务。有针对性的高级课程将提供行为经济学，以用户为中心的设计和实施科学的培训，以促进这些职业目标。在研究目标1中，我们将与患者和供应商合作伙伴进行需求评估，以制定我们的干预措施，推动供应商使用RED并促进相关护理。在目标2中，我们将评估干预的可用性，以确保其适当触发并符合临床工作流程。在目标3中，我们将在区域胃肠病学实践中开展干预，以评估其有效性和实践实施情况。该项目将为R01提供必要的初步数据，以支持更大规模的随机试验。通过K23的结论，申请人将定位于学术成功，在创造变革性的临床护理途径中占据一席之地，利用诊断技术将三级护理范式下游拉到一般护理环境中，以改善受GI动力障碍影响的患者的健康，实践中最常见的GI疾病。

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.