Yale Clinical and Translational Science Award: Calhoun Diversity in Health Related Research

候选项目摘要--广泛实施循证干预措施 例如预防性青霉素和肺炎球菌疫苗，镰状细胞病(SCD)已经从一种 从儿童时期的危及生命的疾病到一种慢性疾病，成年后寿命显著缩短。SCD 患者从儿科过渡到成人护理时，预后不良的风险最大，在这段时间里， 疾病进展和社会经济并发症汇聚在一起。有证据表明，实施 支持患者和护理人员的结构化过渡计划将有助于缓解许多挑战 当它们在这片复杂的地貌中航行时，阿雅-SCD面对的是。美国儿科学会已经 发布了全面的指导方针，支持医疗保健从青春期向成年期过渡 在医疗院，它在改善青少年过渡护理方面显示出希望。尽管如此， 针对患有SCD的青少年和年轻人的结构化过渡计划仍然很少。在这 建议，我将使用实施科学方法来促进更多地采用AAP准则 进入临床实践，长期目标是增加结构化过渡计划的存在 Aya-SCD.为了实现这一目标，我将使用干预映射，这是一种基于科学的实现 规划框架，深思熟虑地确定一套核心实施战略，以促进 根据AAP指南(目标1)制定结构化过渡方案。然后我会试飞这些 在地方一级评估可行性和可接受性的战略(目标2)。这些数据将向多个- 中心研究旨在结合AAP指南使用经过验证的实施战略，以促进 增加Aya-SCD的结构化过渡方案，以降低发病率为长期目标 这一高风险群体深受医疗保健不平等的影响。我将利用 在YCCI的资源，以成功执行拟议的项目以及发展我的专业知识 实施科学、临床研究方法、健康公平和干预设计；这包括说教 YCCI提供的课程，参加每月的YCCI研究进展研讨会并继续 参与临床和转译研究机会(ROCATS)队列 为致力于临床和转化性研究的初级教师提供基础知识。我也会 在研究发展、执行和成果传播过程中与基督教青年会文化大使接触 以确保我的学术工作能反映SCD社区的需求。在我的指导下 导师小组，其中包括镰状细胞病、实施科学和卫生公平方面的专家 YCCI提供的成果研究和职业发展资源将实现我的长期目标 成为一名独立的内科科学家，致力于通过 严格设计和实施多层次健康干预措施。

CANDIDATE PROJECT ABSTRACT - With the widespread implementation of evidence-based interventions such as prophylactic penicillin and pneumococcal vaccinations, sickle cell disease (SCD) has evolved from a life-threatening disease of childhood to a chronic condition with a strikingly shortened adult life span. SCD patients are at greatest risk for poor outcomes as they transition from pediatric to adult care, a time in which disease progression and socioeconomic complications converge. Evidence suggests that the implementation of structured transition programs to support patients and caregivers will help mitigate many of the challenges that AYA-SCD face as they navigate this complicated landscape. The American Academy of Pediatrics has published a comprehensive guideline, Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home, which has shown promise in improving transition care for adolescents. Nonetheless, there remains a paucity of structured transition programs for adolescents and young adults with SCD. In this proposal, I will use Implementation Science methods to promote the increased uptake of the AAP guidelines into clinical practice with the long-term goal of increasing the presence of structured transition programs for AYA- SCD. To accomplish this objective, I will use Intervention Mapping, an implementation science-based planning framework, to thoughtfully identify a core set of implementation strategies that will facilitate the development of structured transition programs based on the AAP guidelines (Aim 1). I will then pilot these strategies at a local level to evaluate for feasibility and acceptability (Aim 2). These data will inform a multi- center study aimed at using proven implementation strategies in conjunction with AAP guidelines to facilitate the increase of structured transition programs for AYA-SCD with the long-term goal of decreasing morbidity and mortality in this high risk group which is deeply impacted by healthcare inequities. I will leverage the resources at YCCI to successfully execute the proposed project as well as to develop my expertise in Implementation Science, clinical research methods, health equity and intervention design; this includes didactic coursework offered by YCCI, participation in monthly YCCI Research In Progress seminars and continued participation in the Research Opportunities for Clinical and Translational Studies (ROCATS) cohort which provides foundational knowledge to junior faculty committed to clinical and translational research. I will also engage with the YCCI Cultural Ambassadors during study development, execution and dissemination of results to ensure that my scholarly work reflects the needs of the SCD community. With the guidance of my mentorship team, which includes experts in sickle cell disease, implementation science and health equity outcomes research, and the career development resources provided by YCCI I will achieve my long-term goal of becoming an independent physician-scientist dedicated to improving health outcomes in AYA-SCD through the rigorous design and implementation of multi-level health interventions.