Enhancing Inter-Facility Transfer for Patients with Acute Myocardial Infarction

 描述（由申请人提供）：在美国，每年有近500，000名患者患有ST段抬高型心肌梗死（STEMI）。大多数急诊科（ED）缺乏进行直接经皮冠状动脉介入（PCI）治疗心肌再灌注的本地能力。因此，必须将患者转移到有能力的设施，但该过程中的效率低下导致及时心肌再灌注延迟并使患者结局恶化。ST段抬高型心肌梗死患者的再灌注时间大大落后于直接到PCI中心的患者，并且在90%的病例中未能达到国家基准标准。在转移ED时，对护理时间和过程的测量和理解不足，阻碍了STEMI患者转移及时性的改善。此外，关系协调，沟通和组织设计的研究，统称为“组织行为”，是一个公认的方法来研究复杂的卫生系统的性能和变化。它尚未应用于ST段抬高型心肌梗死患者的转移，但可能会揭示重要的干预目标。该提案描述了一个职业发展计划，使候选人获得专业知识，在组织行为如何影响病人护理，通过收购先进的定性和定量的技能，为未来的实施研究。具体目标是：1）检查转移艾德数据中与心肌再灌注延迟相关的因素; 2）对影响直接PCI患者转移的实践进行详细的定性研究; 3）检查关系协调与转移ED所花费时间之间的关联。候选人是唯一合格的急诊医生和运营管理博士候选人。职业发展计划在此基础上提供：a）定性方法的高级技能（例如，患者和工作人员的访谈技巧，观察），生物统计学，和组织理论; B）通过手稿准备，资助写作和会议演示进一步发展科学沟通技能;和c）与国际专家在护理，定性研究，过程干预开发和试验设计的过渡方面的多学科指导研究经验。机构环境是杰出的，包括定性研究中心;在候选人的研究领域的国家排名研究生课程;和国家CTSA协调中心。该职业发展奖将使候选人能够发展在设施间患者转移期间测量医疗保健系统性能的专业知识，深入了解系统性能与患者结局之间的关系，以及干预目标，以提高心肌梗死患者护理的及时性。该奖项将使候选人成为R 01资助的独立调查员，负责实施和评估过程干预措施以改善患者结局。

 DESCRIPTION (provided by applicant): In the U.S., nearly 500,000 patients suffer an ST-elevation myocardial infarction (STEMI) each year. Most emergency departments (EDs) lack the local capabilities to perform primary percutaneous coronary intervention (PCI) for myocardial reperfusion. Thus, patients must be transferred to capable facilities, but inefficiencies in this process cause delays in timely myocardial reperfusion and worsen patient outcomes. The time to reperfusion for transferred STEMI patients greatly lags behind those patients who present directly to PCI centers and fails to meet national benchmark standards in 90% of cases. Inadequate measurement and understanding of the timing and processes of care at transferring EDs has hindered improvement in the timeliness of STEMI patient transfer. Moreover, the study of relational coordination, communication, and organizational design, collectively known as "organizational behavior," is an accepted approach to study performance and variation in complex health systems. It has not yet been applied to the transfer of STEMI patients, but would likely reveal important targets for intervention. This proposal describes a career development plan that enables the candidate to gain expertise in how organizational behavior affects patient care, through the acquisition of advanced qualitative and quantitative skills for future implementation studies. The Specific Aims are: 1) Examine transferring ED data for factors associated with delays to myocardial reperfusion; 2) Conduct a detailed qualitative study of the practices that affect patient transfer for primary PCI; and 3) Examine the association between relational coordination and time spent at transferring EDs. The candidate is uniquely qualified as an emergency physician and PhD candidate in operations management. The career development plan builds on this foundation to provide: a) advanced skills in qualitative methods (e.g., patient and staff interviewing skills, and observation), biostatistics, and organizational theory; b) further development of scientific communication skills through manuscript preparation, grant writing, and conference presentations; and c) a multidisciplinary mentored research experience with international experts in transitions of care, qualitative research, process intervention development, and trial design. The institutional environment is outstanding, including a qualitative research center; nationally ranked graduate programs in the candidate's fields of study; and the national CTSA coordinating center. This career development award will allow the candidate to develop expertise in measuring the performance of healthcare systems during inter-facility patient transfer, a deep understanding of the relationship between system performance and patient outcomes, and targets for intervention to improve the timeliness of patient care for myocardial infarction. This award will position the candidate to become an R01-funded independent investigator who implements and evaluates process interventions to improve patient outcomes.