TRACE-CORE

描述（由申请人提供）：急性冠状动脉综合征（ACS）是冠心病患者住院的常见原因，是常见和高风险的。尽管近几十年来在ACS的管理方面取得了显着的进步，但未实现的健康收益仍然来自对ACS后患者的可用证据的利用不足。拟议的冠状动脉事件结局研究和教育中心（TRACE-CORE）的转变、风险和行动将招募一个新的ACS后患者纵向队列，使用该队列开展两个研究项目，并发展四名早期研究者（ESI）的职业生涯。我们有四个具体目标。1)我们将招募2，500名年龄为21-I-，18%为非洲裔美国人和10%为西班牙裔的患者，在他们从马萨诸塞州和格鲁吉亚的8个医疗中心的ACS住院治疗中出院时，进行为期2年的COHORT随访。我们将从索引中提取医疗记录以及随后的住院和门诊记录。在出院时以及2周和6周以及3个月、12个月和24个月后的患者访谈将包括生活质量（QoL）、认知障碍、药物依从性和健康相关行为的测量。2)过渡项目：我们将描述ACS后出院患者的90天过渡过程。我们将聘请一个全国性的专家小组来制定一个基于证据的过渡测量集，反映出院后的前90天，并超越现有的专注于出院过程的系统。我们将检验关于护理质量和结果（包括再住院和生活质量）之间关系的假设，特别是当它们与健康差异有关时。3)行动评分项目：我们将开发和验证两种新的“行动评分”，预测临床事件/死亡率和生活质量，并强调医疗保健服务和患者行为的可修改方面。4)使用TRACE-CORE作为培训实验室，我们将开发四个ESI的CVD结果研究生涯。这将包括结构化指导、ESIs astheco-PI在研究项目中的关键参与，以及基于TRACE-CORE基础设施和发现准备新的研究提案。我们的团队包括杰出的CVD结果研究人员，方法学家，心脏病学家和其他临床医生。我们创新的行动评分应该激励患者和提供者改善CVD结果;我们的过渡项目将填补重要的知识空白。未来的研究将受益于我们的数据，基础设施，行动评分和过渡措施;在这些基础上建立也将巩固未来CVD结果研究人员的职业生涯。

DESCRIPTION (provided by applicant): Acute Coronary Syndromes (ACS), the usual reason for hospitalization of patients with coronary heart disease, is common and high-risk. Despite remarkable advances in the management of ACS in recent decades, unrealized health gains remain from underuse of available evidence for post-ACS patients. The proposed Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) will recruit a new longitudinal cohort of post-ACS patients, conduct two research projects using the cohort, and develop the careers of four early stage investigators (ESIs). We have 4 specific aims. 1) We will recruit and follow for 2 years a COHORT of 2,500 individuals, age 21-I-, 18% African-American and 10% Hispanic, at the time of their discharge from an ACS hospitalization at 8 medical centers in Massachusetts and Georgia. We will abstract medical records from the index and subsequent hospitalizations and outpatient records. Patient interviews at the time of discharge and at 2 and 6 weeks, and 3, 12, and 24 months later will include measurements of quality of life (QoL), cognitive impairment, adherence to medications, and health related behaviors. 2) TRANSITIONS PROJECT: We will characterize the 90-day transition process for patients discharged after an ACS. We will engage a national panel to develop an evidence-based Transition Measurement Set reflecting the first 90 days after discharge and going beyond existing systems that focus on the discharge process. We will test hypotheses on the associations between quality of care and outcomes (including rehospitalization and QoL), particularly as they pertain to health disparities. 3) ACTION SCORES PROJECT: We will develop and validate two novel "Action Scores" that predict clinical events/mortality and QoL and which emphasize modifiable aspects of health care delivery and patient behaviors. 4) Using TRACE-CORE as a training laboratory, we will develop the CVD outcomes research careers of the four ESIs. This will include structured mentoring, key involvement of the ESIs astheco-PIs in the research projects, and preparation of new research proposals based on the TRACE-CORE infrastructure and findings. Our team involves prominent CVD outcomes researchers, methodologists, cardiologists, and other clinicians. Our innovative Action Scores should activate patients and providers to improve CVD outcomes; our Transitions Project will fill important knowledge gaps. Future studies will benefit from our data, infrastructure, Action Scores, and transition measures; building on these will also underpin the careers of future CVD outcomes researchers.