Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK)

项目摘要/摘要 建议的应用程序旨在开发、实施和评估质量改进的影响 关于急性冠脉综合征(ACS)后30天主要心血管不良事件发生率的工具包 印度喀拉拉邦的一项整群随机阶梯式楔形临床试验设计。系统级质量改进 非洲联盟的倡议虽然在高收入国家取得了成功，但在低收入和低收入国家尚未得到广泛评估 中等收入国家(LMIC)，但可能是心血管领域的创新来源 实施科学。这项提案将利用喀拉拉邦ACS注册处的研究基础设施， 该公司最近完成了过去两年从25,000名ACS参与者那里收集的数据。 该提案还包含两项子研究，将评估喀拉拉邦急性冠脉综合征对患者的影响， 可作为印度和其他LMIC的典范。第一项子研究旨在评估冠心病-- 使用经过语言验证的西雅图心绞痛问卷对急性冠脉综合征患者的特定生活质量(翻译 并从英语到马拉拉语(喀拉拉邦当地语言)进行验证)。西雅图心绞痛调查问卷 调查患者的身体限制、症状、治疗满意度和疾病认知。第二 一项子研究旨在评估美国癌症协会事件在个人和家庭层面上的贫困影响 最近实施的一项国家政府保险方案(Rashtriya Swthya Bima Yojna)为贫困线以下的家庭提供援助。该提案还包括一个探索性目标，以执行定性 工具包开发方面的研究。这一目标将在质量改进中纳入焦点小组讨论 团队成员确定在当地开发最佳ACS护理的促进者和障碍- 开发与提供者相关的工具包组件(临床路径、入院/出院核对表，例如)也是 作为对患者认知访谈中与患者相关的工具包组件的开发(出院 教育/信息材料)。 在该奖项的职业发展期间，我将在以下位置进行以患者为中心的ACS注册培训 圣卢克/中美心脏研究所由约翰·斯珀图斯博士领导，他是该领域的全国领先者。我要上几门课 在研究伦理、项目评估和卫生经济学方面，以补充我之前的培训。这就做 与卡利普索·查尔基杜博士通过NICE国际参加培训研讨会/飞行员，NICE国际是 英国国家健康与临床卓越研究所(NICE)，以了解证据的发展- 适用于当地国家环境和医疗保健系统的知情的临床标准和指南。 我拥有公共卫生、心脏病学和Fogarty全球健康培训的独特组合， 印度的心血管流行病学研究，将为该项目提供坚实的基础。这个 指导和咨询团队由美国和印度在全球心血管流行病学、公共卫生和公共卫生领域的领导者组成 健康，高质量的护理和结果，并将为我的职业发展和 研究本身。 相关性 由印度从业者开发改善急性冠脉综合征护理的当地解决方案可能会提供创新的想法 与美国相关并适用于美国的法律。因此，本提案旨在改善对急性冠脉综合征患者的护理 在印度，并捕捉全球卫生的创新潜力，这是NIH的一个主题目标，也是任务的一部分 NHLBI的。

PROJECT SUMMARY/ABSTRACT The proposed application aims to develop, implement, and evaluate the impact of a quality improvement toolkit on 30-day major adverse cardiovascular event rates following acute coronary syndrome (ACS) through a cluster-randomized, stepped wedge clinical trial design in Kerala, India. System-level quality improvement initiatives in ACS, while successful in high-income countries, have not been extensively evaluated in low- and middle-income countries (LMIC), yet could be sources of innovation in the field of cardiovascular implementation science. This proposal will leverage the research infrastructure from the Kerala ACS Registry, which recently completed data collection from >25,000 ACS participants over the past 2 years. The proposal also contains 2 sub-studies that will evaluate the patient-level impact of ACS in Kerala, which may serve as a model for India and other LMIC. The first sub-study aims to evaluate coronary heart disease- specific quality of life following ACS using a linguistically-validated Seattle Angina Questionnaire (translated and validated from English to Malayalam, the local language of Kerala). The Seattle Angina Questionnaire surveys patients' physical limitations, symptoms, treatment satisfaction, and disease perception. The second sub-study aims to evaluate individual- and household-level impoverishing effects of an ACS event in the context of the recent implementation of a national government insurance program (Rashtriya Swathya Bima Yojna) for families below the poverty line. The proposal also includes an exploratory aim to perform qualitative research in toolkit development. This aim will incorporate focus group discussions among quality improvement team members to determine facilitators and barriers to optimal ACS care in the development of locally- developed provider-related toolkit components (clinical pathways, admission/discharge checklists, e.g.) as well as cognitive interviews with patients in the development of patient-related toolkit components (discharge education/information materials). During the career development period of this award, I will pursue patient-centered ACS registry training at St. Luke's/Mid-America Heart Institute under Dr. John Spertus, a national leader in the field. I will take courses in research ethics, program evaluation, and health economics to complement my prior training. I will participate in training workshops/pilots with Dr. Kalipso Chalkidou through NICE International, a division of the UK National Institute for Health and Clinical Excellence (NICE), to learn about the development of evidence- informed, clinical standards and guidelines adapted to local country settings and healthcare systems. I have a unique combination of public health, cardiology, and Fogarty global health training and cardiovascular epidemiology research in India that will provide a strong foundation for this project. The mentorship and advisory teams consist of US and Indian leaders in global cardiovascular epidemiology, public health, and quality care and outcomes, and will provide expert guidance for my career development and for the research itself. Relevance Development of local solutions to improving ACS care by Indian practitioners may provide innovative ideas that are relevant to and applicable in the US. As such, this proposal aims to improve the delivery of ACS care in India and capture the innovative potential of global health, a thematic goal of the NIH and part of the mission of the NHLBI.