Implementing a Community-Engaged Amputation Prevention Intervention in Rural Patients with Diabetes and Peripheral Arterial Disease

截肢是糖尿病（DM）和外周动脉疾病的一种毁灭性但可预防的并发症 (PAD)它是严重心血管疾病和护理质量差异的标志。 尽管农村人群存在多种截肢风险因素，但截肢率仍存在关键差距 农村社区的研究，关于截肢预防干预措施的数据很少 旨在满足这些社区改善健康结果的需求。West Virginia（WV），a 这个高度农村化的州是全国糖尿病和心血管疾病患病率最高的州之一， 是一个非常需要创新解决方案来防止这些并发症的地方。我的长期职业生涯 目标是成为健康差异研究的临床研究员，专注于设计和 实施社区参与的干预措施，降低糖尿病患者的截肢率 的PAD。我在这一领域的初步工作表明， WV比全国平均水平高出6倍。此外，尽管调整了多重风险， 由于这些因素，截肢的风险集中在西弗吉尼亚州的某些高风险地理区域。此指导 职业发展培训奖（K23）是我获得技能、培训和 要实现这一目标，就需要有导师。本研究的目的是制定、实施和评估 截肢预防干预措施，旨在使用在高风险的农村地区， 参与的方式。我将检验中心假设，截肢预防干预 以社区参与的方式制定和实施的方案将是可行的， 高风险农村地区。本研究的具体目的是：1）开发一种基于供应商的截肢 采用社区参与办法，采取适合高风险农村地区的预防干预措施， 2)实施和评估合作开发的、基于供应商的 采用实施研究综合框架的截肢预防干预 （3）将调查结果翻译并传播给 社区利益相关者，然后广泛到其他高风险的农村地区，准备实施 多领域干预效果研究。由强大的多学科导师团队指导， 一个积极的社区参与和外展核心与既定的提供者为基础的研究 通过WV临床和转化科学研究所的网络，我准备成功地进行 这项研究计划在农村西弗吉尼亚州。K23奖项的培训和研究计划将使我能够 实现我的长期职业目标，成为血管外科领域的领军人物，同时具备肢体 保存和设计并实施社区参与的干预措施，以解决血管 与疾病相关的健康差距。

Amputation is a devastating but preventable complication of diabetes (DM) and peripheral arterial disease (PAD); it serves as a marker for severe cardiovascular disease and for disparities in quality of care. Although rural populations have multiple risk factors for amputation, there is a critical gap in amputation research in rural communities, with very little data available on amputation prevention interventions designed to meet the needs of these communities to improve health outcomes. West Virginia (WV), a highly rural state with some of the highest national prevalence rates of DM and cardiovascular disease, is a location in great need of innovative solutions to prevent these complications. My long-term career goal is to become a clinician-investigator in health disparities research focused on designing and implementing community-engaged interventions that will reduce amputation rates in patients with DM and PAD. My preliminary work in this area demonstrated that DM and PAD-related amputation rates in WV are up to 6 times higher than the national average. Moreover, despite adjusting for multiple risk factors, the risk of amputation is clustered in certain high-risk geographic regions in WV. This Mentored Career Development Training Award (K23) is the ideal opportunity for me to obtain the skills, training and mentorship needed to achieve this goal. The objective of this study is to develop, implement and assess an amputation prevention intervention designed for use in high-risk rural areas using community engagement approaches. I will test the central hypothesis that an amputation prevention intervention developed and implemented in a community-engaged fashion will be feasible and acceptable for use in high-risk rural areas. The specific aims of this study are to: 1) develop a provider-based amputation prevention intervention appropriate for high-risk rural areas using community engagement approaches, 2) implement and assess the feasibility and acceptability of the collaboratively-developed, provider-based amputation prevention intervention using the Consolidated Framework for Implementation Research (CFIR) and refine the intervention based on these findings, and 3) translate and disseminate findings to community Stakeholders, and then widely to other high-risk rural areas to prepare for implementation of a multi-area intervention effectiveness study. Guided by a strong multidisciplinary mentorship team and an active Community Engagement and Outreach Core with an established Provider-Based Research Network through the WV Clinical and Translational Science Institute, I am poised to successful conduct this research plan in rural WV. The training and research plan for this K23 award will enable me to achieve my long-term career goal, to become a leader in vascular surgery with both expertise in limb preservation and designing and implementing community-engaged interventions to address vascular disease-related health disparities.