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

项目摘要/摘要 每年花费250亿美元护理因外周动脉导致的下肢溃疡患者 疾病(PAD)和糖尿病(DM)在美国。尽管有超过18.5万名PAD患者， DM，或联合PAD/DM接受腿部截肢，对侧腿截肢的风险为55%。在农村 患者的风险比城市地区高50%。治疗腿部溃疡的指导方针是 建立在踝臂指数(ABI)测试和表征对动脉血流灌注进行客观评价的基础上 使用经过验证的分类系统(WiFi)对溃疡进行分类。实现这两个目标的障碍包括贫穷 在初级提供者中的传播，如何在繁忙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。采用远程医疗管理患者的肢体功能 溃疡发生率一直很低；然而，我们认为，除了传播和传播外，使用远程医疗 实施循证指导方针可以改善护理的时机，并可能减少住院治疗， 急诊室就诊和截肢。 我的长期目标是减少糖尿病和/或足部溃疡患者的可预防截肢 垫子。我的直接目标是发展我作为实现科学研究人员的技能，重点是 向农村诊所提供循证指南，并使用远程医疗提供特殊护理，以及 评估患者激活的效果会影响结果。K23奖将支持我的时间 在农村诊所实施ABI和WiFi使用，并使用远程医疗来改善护理时间，这可能 最终减少住院和截肢。 在UC的环境中，我可以使用几个相关和互补的资源 戴维斯。首先，NIH临床与翻译科学中心(CTSC)代表着一个重要的 资源池，包括赠款和统计支助以及信息学和数据库支助。加州大学戴维斯分校 医疗保健与技术中心(CHT)，Marcin医生担任儿科主任 远程医疗，已经拥有通过远程医疗进行专家会诊所需的所有资源 地点。最后，由喜悦·梅尔尼科夫领导的加州大学戴维斯分校医疗政策和研究中心(CHPR)有一个 在以患者为中心的研究和卫生政策方面拥有丰富经验的定性研究人员的强大网络 研究人员为项目的实施提供方法、专业知识和支持。加州大学戴维斯分校的外科 我是该组织的成员之一，该组织每月召开会议，讨论“正在进行的研究”。这 在我的资助期间，小组将成为审查想法和分析工作的宝贵工具。总体而言，如果没有 加州大学戴维斯分校的协作性质，我不可能在这个提议中成功。

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.