Using Intervention Mapping and the Multiphase Optimization Strategy to develop multilevel interventions to prevent upper GI bleeding

项目摘要/摘要 候选人：雅各布·E·库兰德，医学博士，理学硕士，胃肠病专家和早期职业研究人员，专注于 减轻与上消化道出血(UGIB)相关的疾病负担。有了前师的- 在临床和卫生服务研究方面的高水平培训，他成功地进行了回顾 研究，但在正式的干预研究方面几乎没有经验。这位K23指导职业发展 该奖项将为他提供必要的独特技能来设计和评估创新的、基于理论的 旨在预防UGIB的多层次干预措施。研究背景：消化性溃疡疾病是一种 可能导致出血、肠穿孔和死亡的流行的和病态的情况。处于高风险中 患者，包括许多使用抗血小板治疗或非类固醇消炎药的患者，质子泵 抑制剂(PPI)的胃保护作用可以显著降低PUD的风险。然而，只有不到一半的高危人群 患者会得到适当的胃部保护。面向提供者的干预措施，以改善对 胃部保护只显示出了微弱的成功。多层次干预，以患者为目标，至少 另外两个背景因素(例如，提供商和系统)同时被越来越多地认识到是 提高干预效果的有力策略。然而，理论的发展和评估-- 由于多个相互作用的组成部分，多层次的干预措施是复杂的。研究目的： 库兰德博士将利用干预地图(IM)，这是一个经过验证的基于理论的干预框架 发展，以：(1)深入了解患者、提供者和系统层面的障碍和 促进者通过对患者进行半结构化访谈来适当地进行PPI胃部保护， 提供者和其他关键信息提供者；(2)设计和制作以理论为基础的多层次干预 以患者、提供者和卫生系统为目标；(3)评估 单点先导性研究中的多水平干预。这项试点将作为多阶段的第一步 优化策略(MOST)，一个逐步准备、优化和评估的框架 多组分干预。培训目标：库兰德博士将在以下方面发展专业知识：(1)定性 理解卫生保健提供的背景方面的研究方法；(2)基于理论的、多层次的 (3)多层次干预措施的评价与优化方法。他也 将接受负责任的研究行为方面的具体培训。库兰德博士的培训将得到支持 由经验丰富的跨学科导师、高级教学课程和参与研究 在理想的培训环境中举办职业发展会议/研讨会。作为被指导的结果 从这个奖项开始的研究培训，Kurlander博士将成为一名独立的调查员，在 设计和优化强大的下一代多层次干预措施，以改变 上消化道出血。

PROJECT SUMMARY/ABSTRACT Candidate: Jacob E. Kurlander, MD, MSc is a gastroenterologist and early career investigator focused on reducing the burden of disease associated with upper gastrointestinal bleeding (UGIB). With prior master's- level training in clinical and health services research, he has been successful in conducting retrospective research but has little experience with formal interventional studies. This K23 mentored career development award will provide him with the unique skills necessary to design and evaluate innovative, theory-based, multilevel interventions aimed at prevention of UGIB. Research Context: Peptic ulcer disease (PUD) is a prevalent and morbid condition that can result in hemorrhage, intestinal perforation, and death. In high-risk patients, including many who use antiplatelet therapy or nonsteroidal anti-inflammatory drugs, proton pump inhibitor (PPI) gastroprotection can dramatically reduce the risk of PUD. However, fewer than half of high-risk patients receive appropriate gastroprotection. Provider-facing interventions to improve the use of gastroprotection have shown only marginal success. Multilevel interventions, targeting patients and at least two other contextual factors (e.g., providers and systems) simultaneously, are increasingly recognized as a powerful strategy to improve intervention effectiveness. However, the development and evaluation of theory- based, multilevel interventions are complex because of the multiple interacting components. Research Aims: Dr. Kurlander will leverage Intervention Mapping (IM), a validated framework for theory-based intervention development, to: (1) Develop an in-depth understanding of patient-, provider-, and system-level barriers and facilitators to appropriate PPI gastroprotection by conducting semi-structured interviews with patients, providers, and other key informants; (2) Design and produce a theory-based multilevel intervention that targets patients, providers, and the health system; (3) Assess the feasibility, appropriateness, and efficacy of the multilevel intervention in a single-site pilot study. This pilot will serve as the first step of the Multiphase Optimization Strategy (MOST), a framework for progressively preparing, optimizing, and evaluating multicomponent interventions. Training Aims: Dr. Kurlander will develop expertise in: (1) Qualitative research methods to understand contextual aspects of health care delivery; (2) Theory-based, multilevel intervention development; and (3) Evaluation and optimization methods for multilevel interventions. He also will receive specific training in the responsible conduct of research. Dr. Kurlander's training will be supported by highly experienced, interdisciplinary mentors, advanced didactic coursework, and participation in research and career development meetings/seminars within an ideal training environment. As a result of the mentored research training from this award, Dr. Kurlander will become an independent investigator uniquely skilled in the design and optimization of potent, next-generation multilevel interventions to transform the landscape of upper GI bleeding.