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

优化老年外科患者的护理：理论指导的实施科学方法

• 批准号: 10755988
• 负责人: Sevdenur Cizginer
• 金额: $ 24.11万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-04 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10755988
• 关键词: Address; Adoption; Aging; American College of Surgeons; Area; Arrhythmia; Award; Caring; Clinical; Clinical Research; Clinical Trials Design; Cognition; Computerized Medical Record; Consolidated Framework for Implementation Research; Data; Delirium; Development; Elderly; Enrollment; Epidemiology; Evidence based practice; Feasibility Studies; Geriatric Assessment; Goals; Grant; Health Care Costs; Health Services Research; Hospital Costs; Hospitals; Individual; Infrastructure; Interview; Knowledge; Lead; Leadership; Learning; Length of Stay; Maintenance; Methods; Morbidity - disease rate; Older Population; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Patient Care; Patient-Centered Care; Patient-Focused Outcomes; Patients; Peer Review; Perioperative; Persons; Phase; Physician Executives; Pilot Projects; Population; Postoperative Period; Prevention; Process; Protocols documentation; Qualifying; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recovery; Research; Research Personnel; Rhode Island; Risk; Role; Secure; Specific qualifier value; Standardization; Surgical Models; Surgical complication; Testing; Training; Universities; Urology; Work; career; career development; clinical outcome measures; clinical practice; clinically relevant; cost; data integration; design; dissemination science; effectiveness testing; effectiveness/implementation trial; evidence base; experience; falls; hospital readmission; human old age (65+); implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation trial; implementation/effectiveness; improved; improved outcome; inpatient surgery; interdisciplinary collaboration; interest; medical complication; mortality; multidisciplinary; novel; nutrition; older patient; post implementation; programs; prospective; response; routine practice; skills; success; surgical research; theories; tool; uptake; young adult

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.

项目摘要/摘要 这项Nia Paul B. Beeson K76新兴领导者职业发展建议将为Cizginer博士提供 传播和实施方面的批判技能（D＆I）科学并支持她的发展 独立的研究人员和老年手术领导者。她的具体培训目标包括1）获得D＆I 科学和定性研究专业知识，2）临床试验设计和混合方法数据的培训 整合并进行循证实践的混合实施效应试验 手术和3）高级领导培训。老年人占所有住院手术的40％ 患者经历了年轻患者的发病率和死亡率的两倍。鉴于预计的指数 老年人群的增加，有一个紧迫的人可以使住院手术更安全。回应这种紧急 需要，美国外科医生学院（ACS）老年医学手术验证（GSV）计划 介绍了30个基于证据的标准，旨在系统地改善手术护理和结果。 但是，在支持这些标准进入常规实践中的努力很少。 因此，该提案旨在解决有关传播和传播最佳方法的知识差距 实施GSV计划，以改善老年外科患者的预后。这个目标将在 以下目的：AIM 1将确定参加ACS GSV计划的障碍和促进者；目标2 将创建实施策略并解决GSV计划实施的障碍； AIM 3将是 在当地医院进行的试点试验，以测试克服障碍的策略的有效性 GSV实施将生成数据以支持R01建议。 Cizginer博士具有独特的资格 领导这项工作，因为（1）她是布朗的老年手术医学总监，并有经验 实施和评估综合老年手术模型（2）具有以前的临床研究 （3）具有20多个同行评审文章的经验，接受了流行病学和卫生服务的正规培训 研究和（4）缺乏D＆I科学（新研究兴趣）的正式培训和研究经验。 最终，这项工作将为Cizginer博士开展独立研究职业铺平道路 制定新颖而有价值的策略，将基于证据的实践实施为常规临床实践 老年手术患者，降低相关的医疗保健成本并改善患者的预后。