Integrating Perioperative Care into the Treatment of Hypertension

描述(由申请人提供)：应聘者：Robert B.Schonberger博士是耶鲁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，旨在将围手术期的医疗接触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。他近期的研究目标是：1)建立一个预测术后门诊门诊量升高的临床预测模型 用于麻醉医生指导转诊决策的血压，2)确定术后预防性护理随访失败的危险因素，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外科患者的能力。在过渡到独立的过程中，舒恩伯格博士的目标是在未来进行以病人为中心的围手术期干预，以改善高血压的治疗。Schonberger博士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一名独立的研究人员。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/生物统计学方面进行专门培训，以获得成为独立临床医生兼科学家所需的技能。环境：位于康涅狄格州西黑文的耶鲁大学医学院和退伍军人管理局(VA)医疗保健系统为从事临床研究的教师提供强大和互补的资源。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博士的结构化教学将包括侧重于临床研究的硕士学位课程、通过Robert Wood Johnson临床学者计划审计的附属课程，以及由NHLBI和NIH行为和社会科学研究办公室赞助的夏季随机行为临床试验研究所。临床研究资源将包括一个大型城市外科中心、一个附属的初级保健中心、一个当地的 远程健康办公室拥有实施和跟踪家庭血压测量的经验，耶鲁医学信息学中心的信息学基础设施，耶鲁大学公共卫生学院耶鲁分析科学中心的统计支持，以及退伍军人管理局指定的信息学中心--退伍军人管理局康涅狄格州退伍军人管理局的国家数据库资源。研究：这项K23指导的以患者为导向的研究职业发展奖提出了一系列三项研究，为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介奠定了科学基础。在围手术期之外，数据明显表明，尽管在医疗保健上花费了越来越多的钱，但在美国，相当数量的高血压患者仍然没有得到诊断或高血压治疗不足。鉴于已知的引起围手术期血压变化的几个因素，目前还没有被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以国家电子病历(EMR)为基础的队列，开发一种围术期临床预测模型，用于识别门诊手术患者中未诊断和控制不佳的高血压。相同的基于电子病历的队列将被用于第二项研究，该研究将确定高风险失去预防性护理后续护理的门诊外科患者的特征。第三项研究将是对研究1中开发的围术期血压转诊模型的前瞻性验证，还将包括一项患者评估，重点是确定导致该研究人群血压控制不佳的经验性因素。该项目旨在减少非卧床手术患者中未确诊或治疗不足的高血压造成的长期心血管疾病负担，这与国家心肺血液研究所支持旨在预防和治疗心血管疾病的研究的既定使命是一致的。

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.