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

周围动脉疾病患者报告的结果措施的实施和有效性

• 批准号: 10752580
• 负责人: Teryn Allene Holeman
• 金额: $ 3.83万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10752580
• 关键词: Achievement; Adult; Ankle; Blood Vessels; Blood flow; Caring; Characteristics; Chronic; Clinic; Clinical; Communication; Data; Data Analyses; Delphi Technique; Detection; Disease Progression; Effectiveness; Environment; Exercise Therapy; Fellowship; Focus Groups; Foundations; Future; Goals; Health; Institution; Intervention; Interview; Joints; Knowledge; Learning; Limb structure; Managed Care; Measures; Medical; Mental Depression; Mentorship; Modeling; Monitor; Morbidity - disease rate; National Research Service Awards; Operative Surgical Procedures; Outcome; Outcome Measure; Patient Care; Patient Outcomes Assessments; Patient-Centered Care; Patient-Focused Outcomes; Patients; Perception; Peripheral arterial disease; Physical Function; Process; Provider; Psyche structure; Qualifying; Qualitative Research; Quality of life; Recovery; Reporting; Research; Research Methodology; Resources; Scientist; Solid; Statistical Methods; Structure; Surgeon; Surgical Management; Time; Training; Translating; United States; Vascularization; Voice; Work; blood flow measurement; care delivery; clinical care; clinical outcome measures; clinical practice; design; effectiveness/implementation hybrid; future implementation; health care delivery; implementation efforts; implementation framework; implementation science; implementation strategy; improved; indexing; mortality; prospective; routine care; skills; social; social engagement; success; time use; tool

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.

摘要 外周动脉疾病（PAD）是成年人发病和死亡的最常见原因之一， 美国的这种情况下需要手术治疗的患者数量预计将接近 在接下来的30年里翻了一番。有症状的PAD患者被转诊至血管外科医生， 潜在的治疗选择：通过血运重建进行手术治疗或通过 监督运动疗法。尽管症状缓解是治疗的主要目标，但没有客观的 PAD护理中使用的结果，以反映患者的观点。患者报告结局指标（PROM）为 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， 以病人为中心的护理PROM用于监测其他医疗条件和环境中的健康变化， PROM在PAD患者中的效用尚未得到充分证实。传统上，血管外科医生 使用客观指标，如踝肱指数（ABI）血流测量，以评估进展， 决定干预的成功。尽管PROM广泛存在，但目前尚不清楚 如何将这些指标用于临床工作流程和PAD患者的医疗服务。中央 本研究的目的是开发一个成功的实施策略，为PROMs作为病人的声音 用于PAD的常规临床护理。更具体地说，我们将研究物理功能PROM的变化 和ABI随时间动态地相互影响（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、抑郁和社会活动参与 患者（目标1.2）。接下来，我们将使用半定量的方法， 结构化患者访谈（目标2）。最后，我们将通过一个多层次的利益相关者咨询小组， 用改进的Delphi将PROMs纳入PAD患者的常规临床工作流程的策略 方法（目标3）。这些数据将提供必要的上下文组件（目标1和2），以帮助设计一个 将PROM（目标3）成功策略纳入PAD患者的常规临床实践。这项工作将奠定 今后执行工作的基础是在我们的机构和其他机构使用方案执行机构。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PROM用于研究 并拥有资源和临床环境来实施临床实践中的变化。在执行这些 目标，我将获得有价值的知识，使用定性研究方法，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，手术和患者护理的交叉点获得独特的技能， 为将来成为一名血管外科医生和科学家奠定了坚实的基础。