Integrating Perioperative Care into the Treatment of Hypertension

将围手术期护理纳入高血压治疗

• 批准号: 9127316
• 负责人: ROBERT SCHONBERGER
• 金额: $ 17.4万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9127316
• 关键词: Adult; African American; Algorithms; Ambulatory Care; Ambulatory Surgical Procedures; Anesthesiology; Award; Biometry; Blood Pressure; Calibration; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Characteristics; Clinic; Clinical; Clinical Informatics; Clinical Research; Clinical Trials Design; Comorbidity; Computerized Medical Record; Connecticut; Data; Databases; Degree program; Development; Discrimination; Disease; Environment; Epidemiology; Faculty; Failure; Foundations; Future; Goals; Health; Health Promotion; Health Services Research; Healthcare; Healthcare Systems; Heart; Heart Diseases; Home environment; Hypertension; Informatics; Intervention; Master' s Degree; Measurement; Measures; Medical; Medical Informatics; Mentored Patient-Oriented Research Career Development Award; Mentors; Mission; Modeling; Morbidity - disease rate; Morphologic artifacts; NCI Scholars Program; National Heart, Lung, and Blood Institute; Operative Surgical Procedures; Outcome; Pathway interactions; Patient Care; Patients; Performance; Perioperative; Perioperative Care; Pharmacy facility; Physicians; Population; Population Heterogeneity; Postoperative Period; Predictive Value; Prevention; Preventive Health Services; Preventive care; Primary Health Care; Productivity; Public Health; Public Health Schools; Randomized; Reading; Reproducibility; Research; Research Personnel; Research Support; Research Training; Resources; Risk Factors; Science; Scientist; Self Perception; Series; Services; Staging; Structure; Sum; Training; Underserved Population; United States; United States Department of Veterans Affairs; United States Dept. of Health and Human Services; United States National Institutes of Health; Universities; Validation; Visit; Wood material; base; behavioral clinical trial; behavioral/social science; blood pressure regulation; burden of illness; cardiovascular health; cardiovascular risk factor; career; career development; cohort; cost; cost effective; disorder prevention; experience; follow-up; high risk; hypertension control; hypertension treatment; improved; informatics infrastructure; medical schools; medication compliance; mortality; patient oriented; professor; prospective; screening; skills; social science research; study population; success; summer institute; telehealth

DESCRIPTION (provided by applicant): Candidate: Dr. Robert B. Schonberger is a board certified anesthesiologist and Assistant Professor in the Department of Anesthesiology at the Yale School of Medicine. His long-term career goal is to conduct research that aims to transform the perioperative healthcare encounter into an integrated effort at overall health promotion, disease prevention, and longitudinal care of surgical patients. His immediate research goals are 1) to establish a clinical prediction model for predicting elevated postoperative ambulatory clinic blood pressure for use by anesthesiologists to guide referral decisions, 2) to identify risk-factor for post surgical failure of preventive care follow-up, and 3) to prospectively validate the clinicl prediction model's ability to identify ambulatory surgical patients with poor blood pressure control. As he transitions to independence, Dr. Schonberger aims in the future to conduct patient-oriented perioperative interventions to improve the treatment of hypertension. Dr. Schonberger has brought together mentors from the fields of primary care, health services research, hypertension research, informatics, anesthesiology, clinical trials design, and epidemiology that have a shared commitment to the success of this research enterprise and to the development of the candidate into an independent investigator. As part of his career development, Dr. Schonberger will pursue specific training in clinical informatics and health services research, clinical trials design, and epidemiology/ biostatistics in order to attain the skills necessary to become an independent clinician-scientist. Environment: The Yale University School of Medicine and the Veterans Administration (VA) Healthcare System in West Haven, Connecticut provide robust and complementary resources to faculty pursuing clinical research. Together these centers will provide the clinical research and training resources necessary for Dr. Schonberger's research and professional development. Structured didactics for Dr. Schonberger will include a Masters degree program focusing on clinical research, affiliated coursework audited through the Robert Wood Johnson Clinical Scholars program, and the Summer Institute on Randomized Behavioral Clinical Trials sponsored by the NHLBI and the NIH Office of Behavioral and Social Sciences Research. Clinical research resources will include the diverse population of a large, urban surgery center, an affiliated primary care center, a local office of telehealth with experience implementing and tracking home blood pressure measurements, the informatics infrastructure of the Yale Center for Medical Informatics, statistical support from the Yale Center for Analytical Sciences at the Yale School of Public Health, and the national database resources of the VA Connecticut, a designated informatics center within the U.S. Veterans Administration. Research: This K23 Mentored Patient-Oriented Research Career Development Award proposes a series of three studies to establish the scientific foundations for anesthesiologist-initiated blood pressure screening and subsequent primary care referral of ambulatory surgical patients. Outside the perioperative period, the data are manifest that despite increasingly large sums of money spent on healthcare, a significant number of patients with hypertensive disease in the United States remain either undiagnosed or undertreated for their hypertension. Given the several factors that are known to cause perioperative blood pressure changes, there are currently no widely accepted parameters for blood pressure screening and follow-up specifically tailored to the perioperative period. The first study of the present award aims to develop, by means of a national electronic medical record (EMR)-based cohort, a perioperative clinical prediction model for identifying undiagnosed and poorly controlled hypertension among ambulatory surgical patients. This same EMR-based cohort will then be used for a second study that will identify the characteristics of ambulatory surgical patients at high-risk for loss to preventive care follow-up. The third study will be a prospective validation of the perioperative blood pressure referral model developed in Study 1 and will also include a patient assessment focused on the identification of experiential factors that contribute to poor blood pressure control in this study population. By aiming to decrease the long-term cardiovascular disease burden caused by undiagnosed or undertreated hypertension among ambulatory surgical patients, this project is consistent with the National Heart Lung and Blood Institute's stated mission to support research aimed at the prevention and treatment of cardiovascular disease.

描述（由申请人提供）：候选人：Dr. Robert B。Schonberger是耶鲁大学医学院麻醉学系的董事会认证麻醉师和助理教授。他的长期职业目标是进行研究，旨在将围手术期医疗保健转变为整体健康促进，疾病预防和手术患者纵向护理的综合努力。他的近期研究目标是：1）建立一个预测术后门诊升高的临床预测模型 血压，以供麻醉师使用来指导转诊决策，2）识别预防性护理随访的术后失败的风险因素，以及3）前瞻性地验证临床预测模型识别血压控制不良的门诊手术患者的能力。随着他向独立过渡，Schonberger博士的目标是在未来进行以患者为导向的围手术期干预，以改善高血压的治疗。Schonberger汇集了来自初级保健，卫生服务研究，高血压研究，信息学，麻醉学，临床试验设计和流行病学领域的导师，他们共同致力于这项研究事业的成功，并将候选人发展成为独立的研究者。作为其职业发展的一部分，Schonberger博士将在临床信息学和卫生服务研究、临床试验设计和流行病学/生物统计学方面接受专门培训，以获得成为独立临床医生-科学家所需的技能。工作环境：耶鲁大学医学院和康涅狄格州西黑文的退伍军人管理局（VA）医疗保健系统为从事临床研究的教师提供了强大的补充资源。这些中心将共同为Schonberger博士的研究和专业发展提供必要的临床研究和培训资源。Schonberger博士的结构化教学法将包括一个专注于临床研究的硕士学位课程，通过Robert Wood约翰逊临床学者计划审核的附属课程，以及由NHLBI和NIH行为和社会科学研究办公室赞助的随机行为临床试验暑期研究所。临床研究资源将包括一个大型的城市外科中心、一个附属的初级保健中心、一个当地的 该公司拥有远程医疗办公室的经验，实施和跟踪家庭血压测量，耶鲁大学医学信息中心的信息基础设施，耶鲁大学公共卫生学院耶鲁大学分析科学中心的统计支持，以及弗吉尼亚州康涅狄格州的国家数据库资源，美国退伍军人管理局指定的信息中心。研究：这个K23指导的以患者为导向的研究职业发展奖提出了一系列的三项研究，以建立麻醉师发起的血压筛查和随后的门诊手术患者的初级保健转诊的科学基础。在围手术期之外，数据表明，尽管在医疗保健上花费了越来越多的资金，但美国仍有相当数量的高血压患者未被诊断或治疗不足。鉴于已知引起围手术期血压变化的几个因素，目前还没有广泛接受的针对围手术期的血压筛查和随访参数。第一 本奖项的研究旨在通过基于国家电子病历（EMR）的队列研究，开发一种围手术期临床预测模型，用于识别门诊手术患者中未确诊和控制不良的高血压。然后，将使用相同的基于EMR的队列进行第二项研究，该研究将确定预防性护理随访丢失的高风险门诊手术患者的特征。第三项研究将是对研究1中开发的围手术期血压转诊模型的前瞻性验证，还将包括一项患者评估，重点是识别导致该研究人群血压控制不良的经验因素。通过旨在减少门诊手术患者中未确诊或治疗不足的高血压引起的长期心血管疾病负担，该项目符合国家心肺和血液研究所的使命，即支持旨在预防和治疗心血管疾病的研究。