SYNDICARE: Syncope Decision Aid for Emergency Care

 描述(申请人提供)：这项职业发展计划和拟议研究的目标是将首席调查员发展为独立的临床调查员，以改善晕厥患者的紧急护理。晕厥，或一过性意识丧失，是寻求急诊科(ED)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变异性。非诊断性急诊评估后的住院治疗并未显示对患者有益，在某些情况下可能是有害的。这一决定通常是在患者没有就他们的意愿或合理替代方案进行讨论的情况下做出的。共享决策是一个协作过程，在这个过程中，患者和医生一起做出卫生保健决定，考虑到可用的最佳证据以及患者的价值观和偏好。当存在不止一种医学上合理的管理选择时，共享决策是适当的，例如在低风险晕厥患者的门诊和住院管理中。决策辅助工具旨在增加患者对治疗选择和可能结果的了解。改善急诊晕厥护理的另一种手段是应用传播和实施战略，以增加对患者有益的临床干预措施的使用。这项研究方案有以下三个目标：1)利用患者和提供者的输入，初步测试和改进决策辅助工具(名为SynDA)；2)在随机对照试验中评估使用该决策辅助工具的效果；3)实施传播和实施项目，以确定急救护理中的质量差距，并通过定性访谈确定其随机因素。这项研究的结果有可能对美国每年向ED就诊的100万晕厥患者产生积极影响。拟议的活动将为首席研究人员提供临床试验、定性方法以及传播和实施科学领域的知识和技能，以便开发、评估和实施干预措施，以改善ED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.