SYNDICARE: Syncope Decision Aid for Emergency Care

 描述（由申请人提供）：本职业发展计划和拟议研究的目标是将主要研究者发展为独立的临床研究者，以改善晕厥患者的急诊护理。晕厥或短暂性意识丧失是寻求急诊科（艾德）护理的常见原因。它可以由严重的心脏病引起，但通常是良性病因的结果。尽管在这一领域进行了数十年的研究，但这些患者的临床管理仍然存在巨大的差异。在非诊断性艾德评估后住院并没有显示出对患者有益，在某些情况下可能是有害的。这一决定往往是在没有病人的意愿或讨论合理的替代方案的重要投入。共同决策是一个协作过程，患者和医生共同做出医疗保健决策，考虑到最佳可用证据以及患者的价值观和偏好。当存在一种以上医学上合理的管理方案时，共同决策是适当的，如低风险晕厥患者的门诊与住院管理。决策辅助工具是旨在增加患者对治疗方案和可能结果的理解的工具。另一种改善急诊晕厥护理的方法是应用传播和实施策略，以增加已证明对患者有益的临床干预措施的使用。本研究计划有以下三个目的：1）使用患者和提供者的输入进行试点测试和改进决策辅助工具（称为SynDA），2）在随机对照试验中评估使用此决策辅助工具的效果，以及3）进行传播和实施项目，以确定急诊护理的质量差距，并通过定性访谈确定其因果因素。这项研究的结果有可能对美国每年因晕厥而就诊于艾德的100万患者产生积极影响。拟定的活动将为主要研究者提供临床试验、定性方法以及传播和实施科学领域的知识和技能，以开发、评价和实施干预措施，改善艾德晕厥患者的心血管结局。

 DESCRIPTION (provided by applicant): The objective of this career development plan and proposed research is to develop the principal investigator into an independent clinical investigator to improve the emergency care of syncope patients. Syncope, or transient loss of consciousness, is a common reason to seek emergency department (ED) care. It can be caused by serious cardiac disease but is often a result of a benign etiology. Despite decades of research in this area, there remains a huge variability in the clinical management of these patients. Hospitalization after a non-diagnostic ED evaluation has not been shown to benefit patients and may, in some cases, be harmful. This decision is often made without significant input from patients regarding their wishes or discussion of reasonable alternatives. Shared decision-making is a collaborative process in which patients and physicians make a health care decision together, taking into account the best available evidence and the patient's values and preferences. Shared decision-making is appropriate when more than one medically reasonable management options exists, as in out-patient versus in-patient management of low-risk syncope patients. Decision aids are tools designed to increase patient understanding of treatment options and possible outcomes. Another means to improve emergency syncope care is the application of dissemination and implementation strategies to increase the use of clinical interventions proven to benefit patients. This research proposal has the following three aims: 1) Pilot test and refine a decision aid (named SynDA) using input from patients and providers, 2) Evaluate the effects of using this decision aid in a randomized controlled trial, and 3) Conduct a dissemination and implementation project to identify quality gaps in emergency care and determine their casual factors through qualitative interviews. The results of this research have the potential to positively impact the 1 million patients who present to ED with syncope every year in the United States. The proposed activities will provide the principal investigator with knowledge and skills in the areas of clinical trials, qualitative methods, and dissemination and implementation science in order to develop, evaluate, and implement interventions to improve cardiovascular outcomes for ED syncope patients.