An Intervention to Reduce Cancer Associated Thrombosis Through Improved Prophylaxis

候选人：Jordan Schaefer，医学博士是一名血液学家和早期临床研究者，专门从事抗血栓治疗。 治疗，在实施科学和癌症相关的血栓形成（CAT）的特殊利益。 培训目标：K 01职业发展奖将促进Schaefer博士接受定性培训， 研究方法与分析。此外，他将发展实施科学的技能，包括 实施映射，并进行多中心试点实施干预。他会得到这些 通过有重点的指导会议，正式课程，讲习班和研讨会，以及体验式 学习从长远来看，他将利用这种培训来优化和实施多成分干预措施， 促进最好的抗血栓治疗。研究背景：CAT是患者死亡的主要原因 得了癌症研究表明，抗凝血栓预防对高危患者有净获益， 接受系统性癌症治疗的癌症。指导方针广泛支持提供阿哌沙班或利伐沙班 但吸收率极低。一个学术医疗中心能够 将预防率提高到90%以上。然而，这种干预并不普遍适用于 大多数病人接受护理的社区环境。该提案的短期目标是确定 在资源匮乏的社区环境中提高CAT预防率的战略，具有长期目标 具体目标：目标1-查明 在社区肿瘤护理环境中预防CAT的决定因素，以制定一项战略， 改善CAT预防。目的2-制定一项实施计划，以提高药物的吸收 预防CAT使用实施映射。目标3-试行一项执行干预措施， 以社区为基础的肿瘤学实践研究计划：为了实现这些目标，Schaefer博士将执行 基于理论领域框架的半结构化访谈在几个肿瘤学实践中。他将 定期与不同的利益相关者会面，并使用实施映射来建立一个多组件的 执行计划。最后，他将对干预措施进行试点测试，并评估实施情况 六个肿瘤诊所的成果。研究环境：Schaefer博士得到了一个专门的， 多学科团队的成功导师和顾问与他以前合作。的 该项目将得到密歇根肿瘤质量联盟、密歇根抗凝质量 改进倡议，并利用密歇根大学的几个可用资源，包括 医疗保健政策和创新研究所。总结：完成本项目将建立 为更大规模的多中心研究奠定了基础，以确定这种干预措施的临床疗效和可持续性。 该奖项的培训将使Schaefer博士能够成功提交R 01申请，并实现 研究独立性，使用实施科学原则来解决复杂的抗凝问题。

Candidate: Jordan Schaefer, MD is a hematologist and early clinical investigator specializing in antithrombotic therapies, with particular interests in implementation science and cancer associated thrombosis (CAT). Training Aims: This K01 career development award will facilitate Dr. Schaefer receiving training in qualitative research methods and analysis. Furthermore, he will develop skills in implementation science, including implementation mapping, and conducting a multicenter pilot implementation intervention. He will acquire these skills through focused mentorship meetings, formal coursework, workshops and seminars, and experiential learning. Long term, he will use this training to optimize and implement multicomponent interventions to promote best antithrombotic therapies. Research Context: CAT is a leading cause of death among patients with cancer. Studies have shown a net benefit to anticoagulant thromboprophylaxis for high-risk patients with cancer receiving systemic cancer therapy. Guidelines have broadly endorsed offering apixaban or rivaroxaban for this patient population, but uptake has been extremely low. An academic medical center was able to increase prophylaxis rates to over 90% of eligible patients. However, this intervention is not generalizable to community settings where most patients receive their care. The short-term goal of this proposal is to identify strategies to improve rates of CAT prophylaxis rates in low resource, community settings with a long-term goal of broadly disseminating this intervention to reduce the incidence of CAT. Specific Aims: AIM 1–To identify determinants of CAT prophylaxis in community-based oncology care settings to develop a strategy for improving CAT prophylaxis. AIM 2–To develop an implementation plan to improve the uptake of pharmacologic prophylaxis for CAT using implementation mapping. AIM 3–To pilot an implementation intervention at community-based oncology practices. Research Plan: To accomplish these aims, Dr. Schaefer will perform semi-structured interviews based on the Theoretical Domains Framework at several oncology practices. He will meet regularly with diverse stakeholders and use implementation mapping to establish a multicomponent implementation plan. Finally, he will conduct a pilot test of the intervention and assess implementation outcomes six oncology clinics. Research Environment: Dr. Schaefer is supported by a dedicated, multidisciplinary team of accomplished mentors and advisors with whom he has previously collaborated. The project will be supported by the Michigan Oncology Quality Consortium, the Michigan Anticoagulation Quality Improvement Initiative, and make use of several resources available at the University of Michigan, including the Institute for Healthcare Policy and Innovation. Summary: Completing this project will establish the foundation for a larger, multicenter study to establish the clinical efficacy and sustainability of this intervention. The training from this award will prepare Dr. Schaefer to submit a successful R01 application and achieve research independence using implementation science principles to address complex anticoagulation problems.