Evaluating Implementation of Comprehensive Assessment and Telemedicine Consultation to Prevent Amputations for Patients with Lower Extremity Ulcers in Rural Health Clinics.

项目总结/摘要 每年花费250亿美元用于治疗因外周动脉疾病导致的下肢溃疡患者。 疾病（PAD）和糖尿病（DM）。尽管有超过185，000名PAD患者， DM或合并PAD/DM的患者接受腿部截肢，对侧腿部截肢的风险为55%。农村 患者的风险比城市地区高50%。治疗下肢溃疡的指南是 建立在踝臂指数（ABI）测试和表征动脉灌注的客观评价基础上 使用经验证的分类系统（WIfI）进行溃疡的分类。执行这两项措施的障碍包括： 主要提供者之间的传播，如何在忙碌的临床实践中实施工具的问题，以及 获得后续治疗的机会有限。远程医疗在下肢疾病管理中的应用 溃疡的发病率很低;然而，我们认为除了传播和 基于证据的指南的实施可以改善护理的时间安排并且可以减少住院， 急诊室就诊和截肢 我的长期目标是减少糖尿病和/或糖尿病性足溃疡患者的可预防性截肢。 垫.我的近期目标是发展我作为一名实施科学研究人员的技能，重点是 为农村诊所提供循证指南，并利用远程医疗提供专科护理， 评估患者激活的效果影响结果。K23奖将支持我的时间， 在农村诊所使用ABI和WIfI，并使用远程医疗改善护理时机，这可能 最终减少住院和截肢。 在加州大学的环境中，我可以获得几种相关的补充资源 戴维斯首先，NIH临床和转化科学中心（CTSC）代表了一个实质性的 资源库，包括赠款和统计支助以及信息学和数据库支助。加州大学戴维斯 医疗保健和技术中心（CHT），Marcin博士担任儿科主任 远程医疗，拥有通过远程医疗进行专家咨询所需的所有资源， 地方最后，加州大学戴维斯分校医疗保健政策和研究中心（CHPR），由乔伊Melnikow领导，有一个 在以患者为中心的研究以及卫生政策方面具有丰富经验的定性研究人员组成的强大网络 研究人员提供方法方面的专门知识，并支持项目的实施。加州大学戴维斯分校外科 我是成果小组的成员，该小组每月举行会议讨论“进行中的研究”。这 小组将作为一个宝贵的工具，审查的想法和分析工作期间，我的赠款。总的来说，如果没有 在加州大学戴维斯分校的合作性质，我将无法成功地在这个建议。

Project Summary/ Abstract $25 billion is spent annually to care for patients with lower extremity ulcers due to peripheral artery disease (PAD) and Diabetes Mellitus (DM) in the United States. Despite this over 185,000 patients with PAD, DM, or combined PAD/DM undergo leg amputation with a risk of 55% for amputation of the opposite leg. In rural patients the risk is 50% higher compared to urban areas. Guidelines for treating lower extremity ulcers are founded on objective evaluation of arterial perfusion with ankle brachial index (ABI) testing and characterization of the ulcer using a validated classification system (WIfI). Barriers to implementation of both include poor dissemination among primary providers, questions of how to implement tools within a busy clinical practice, and limited access to subsequent treatment. Adoption of telemedicine to manage patients with lower extremity ulcers has been low; however, we believe that the use of telemedicine in addition to dissemination and implementation of evidence based guidelines can improve timing of care and may reduce hospitalizations, emergency room visits, and amputations. My long-term goal is to decrease preventable amputations for patients with foot ulcers due to DM and/or PAD. My immediate goal is to develop my skills as an implementation science researcher with a focus on bringing evidence based guidelines to rural clinics and providing specialty care using telemedicine, and evaluating the effect of patient activation influences outcomes. The K23 award will support my time to implement ABI and WIfI use in rural clinics and to use telemedicine to improve timing of care, which may ultimately decrease hospitalizations and amputations. There are several relevant and complementary resources available to me within the environment at UC Davis. First and foremost, the NIH Clinical & Translational Science Center (CTSC) represents a substantial resource pool including grant and statistical support as well as Informatics and database support. The UC Davis Center for Healthcare and Technology (CHT), where Dr. Marcin serves as the Director of Pediatric Telemedicine, has all the resources needed to conduct specialist consultation through telemedicine already in place. Finally, the UC Davis Center for Healthcare Policy and Research (CHPR), led by Joy Melnikow, has a robust network of qualitative researchers with experience in patient centered studies as well as health policy researchers to provide methods expertise and support implementation of the project. The UC Davis Surgical Outcomes Group, of which I am a member, holds monthly meetings to discuss “research in progress”. This group will serve as a valuable tool for reviewing ideas and analytical work during my grant. Overall, without the collaborative nature at UC Davis, I would not be able to succeed in this proposal.