Optimizing care for older surgical patients: atheory-guided implementation science approach

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PROJECT SUMMARY/ABSTRACT This NIA Paul B. Beeson K76 Emerging Leaders Career Development proposal will provide Dr. Cizginer with critical skills in dissemination and implementation (D&I) science and support her development as an independent researcher and leader in geriatric surgery. Her specific training goals include 1) gaining D&I science and qualitative research expertise, 2) training in clinical trial design and mixed methods data integration, and conducting a hybrid implementation-effectiveness trial for evidence-based practices in geriatric surgery, and 3) advanced leadership training. Older adults make up 40% of all inpatient surgeries, and those patients experience twice the morbidity and mortality of younger patients. Given the projected exponential increase in geriatric population, there is an urgency to make inpatient surgery safer. In response to this urgent need, the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program recently introduced 30 evidence-based standards designed to systematically improve surgical care and outcomes. However, there is a paucity of focused efforts to support the uptake of these standards into routine practice. Thus, this proposal aims to address the knowledge gap regarding the optimal ways to disseminate and implement the GSV program to improve outcomes of older surgical patients. This goal will be met in the following aims: Aim 1 will identify the barriers and facilitators for enrollment to the ACS GSV program; Aim 2 will create implementation strategies and address barriers to GSV Program implementation; and Aim 3 will be a pilot implementation trial in a local hospital to test the effectiveness of the strategies to overcome barriers for GSV implementation, which will generate data to support an R01 proposal. Dr. Cizginer is uniquely qualified to lead this effort as (1) she is the Medical Director of Geriatric Surgery at Brown and has experience implementing and evaluating an integrated geriatric surgery model, (2) has previous clinical research experience with over 20 peer-reviewed articles, (3) has formal training in epidemiology and health services research and (4) lacks formal training and research experience in D&I science (new research interest). Ultimately, this work will pave the way for Dr. Cizginer to launch her independent research career while creating novel and valuable strategies to implement evidence-based practices into routine clinical practice for geriatric surgery patients, reducing related health care costs and improving patient outcomes.