Implementation and Effectiveness of Patient Reported Outcome Measures for Peripheral Arterial Disease

摘要 外周动脉疾病(PAD)是中国成年人发病和死亡的最常见原因之一。 美国。这种情况下需要手术治疗的患者数量预计接近 在未来30年翻一番。有症状性PAD的患者被转介给血管外科医生，他们有两个 可能的治疗选择：通过血运重建进行手术治疗或通过非手术治疗 有指导的运动疗法。尽管缓解症状是治疗的主要目标，但没有客观的 PAD护理中使用的结果反映了患者的观点。患者报告结果衡量标准(PROM)包括 经过验证的强大工具，从患者的角度客观地衡量患者的结果，并帮助提供 以病人为中心的关怀。PROM用于监视其他医疗条件和环境中的健康变化， PROMS在PAD患者中的应用尚未得到很好的证实。传统上，血管外科医生会 使用客观指标，如踝臂指数(ABI)血流测量，评估进展和 决定干预的成功与否。尽管PROM被广泛使用，但目前还不清楚 如何将这些指标用于PAD患者的临床工作流程和医疗保健服务。中环 这项研究的目标是为胎膜早破患者的声音制定一个成功的实施策略 进入PAD的常规临床护理。更具体地说，我们将研究身体机能PROM的变化 和ABI随着时间的推移动态地相互影响(目标1.1)，然后比较PROM随时间的变化 手术和非手术PAD患者的身体功能、抑郁和社交活动 患者(目标1.2)。接下来，我们将获得患者对PROMS在PAD护理中的感知和价值 结构化的患者访谈(目标2)。最后，使用一个多层次的利益相关者咨询小组，我们将设计一个 用改进的Delphi在PAD患者常规临床工作流程中实施PROMS的策略 接近(目标3)。这些数据将提供基本的上下文组件(目标1和2)，以帮助设计 PROMS的成功策略(目标3)成为PAD患者的常规临床实践。这项工作将为 为今后的执行工作奠定基础，重点是在我们机构和其他机构使用PROM。我们的团队是 唯一有资格进行这项研究的人。自2016年以来，我们前瞻性地收集了舞会上的资料进行研究 并拥有在临床实践中实施变革的资源和临床环境。在执行这些操作时 目标，我将获得有价值的知识，运用质的研究方法，轨迹分析，并建立 实施科学框架。在我的导师团队和NRSA奖学金的支持下，我将 在实施科学、外科手术和患者护理的交叉点上获得独特的技能，将提供 作为一名血管外科医生-科学家，为未来的成功奠定坚实的基础。

ABSTRACT Peripheral artery disease (PAD) is the one of the most common causes of morbidity and mortality for adults in the United States. The number of patients needing surgical management for this condition is expected to nearly double over the next 30-years. Patients with symptomatic PAD are referred to vascular surgeons who have two potential treatment options: operative management via revascularization or non-operative management via supervised exercise therapy. Despite symptomatic relief as the primary goal for treatment, there are no objective outcomes used in PAD care to reflect patient’s perspective. Patient reported outcome measures (PROMs) are validated, robust tools that objectively measure patient outcomes from the patient perspective and help deliver patient-centered care. PROMs are used to monitor health changes across other medical conditions and contexts, the utility of PROMs in patients with PAD has not been well-established. Traditionally, vascular surgeons have used objective metrics, like ankle-brachial index (ABI) blood flow measurements, to evaluate progress and determine the success of an intervention. Despite the widespread availability of PROMs, it is presently unclear how these metrics can be used to in the clinic workflow and healthcare delivery of patients with PAD. The central goal of this research is to develop a successful implementation strategy for PROMs as a patient voice into routine clinical care for PAD. More specifically, we will examine how changes in physical function PROMs and ABI influence each other dynamically over time (Aim 1.1) and then compare PROM changes over time for physical function, depression, and social engagement in activities among operative and non-operative PAD patients (Aim 1.2). Next, we will obtain patient perceptions and value of PROMs in PAD care using semi- structured patient interviews (Aim 2). Finally, using a multilevel stakeholder advisory panel we will design a strategy for implementing PROMs into routine clinical workflow for PAD patients using a modified-Delphi approach (Aim 3). These data will provide essential contextual components (Aims 1 & 2) to help design a successful strategy for PROMs (Aim 3) into routine clinical practice for patients with PAD. This work will lay the foundation for future implementation efforts focused on use of PROMs at our institution and others. Our team is uniquely qualified to carry out this research. We have prospectively collected PROMs since 2016 for research and have the resources and clinical environment to implement changes in clinical practice. While executing these aims, I will gain valuable knowledge using qualitative research methods, trajectory analysis, and established implementation science frameworks. With the support of my mentorship team and the NRSA fellowship, I will attain a unique skillset at the intersection of implementation science, surgery, and patient care that will provide a solid foundation for future success as a vascular surgeon-scientist.