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

项目总结/摘要 候选人：雅各布·E. Kurlander，MD，MSc是一名胃肠病学家和早期职业调查员，专注于 减少与上消化道出血（UGIB）相关的疾病负担。先修硕士学位- 在临床和卫生服务研究水平的培训，他已经成功地进行了回顾性研究， 研究，但很少有正式的干预性研究的经验。这K23指导职业发展 奖项将为他提供设计和评估创新，以理论为基础， 旨在预防UGIB的多层次干预措施。研究背景：消化性溃疡病（PUD）是一种 可导致出血、肠穿孔和死亡的流行和病态。在高风险 患者，包括许多使用抗血小板治疗或非甾体抗炎药的患者，质子泵 抑制剂（PPI）胃保护可以显着降低PUD的风险。然而，只有不到一半的高风险 患者接受适当的胃保护。面向提供者的干预措施， 胃保护仅显示出边际成功。多层次干预，针对患者，至少 两个其它上下文因素（例如，供应商和系统）同时，越来越多地被认为是 强有力的战略，以提高干预的有效性。然而，理论的发展和评价- 基于基础的、多层次的干预措施是复杂的，因为有多个相互作用的组成部分。研究目的： 博士Kurlander将利用干预映射（IM），这是一个经过验证的基于理论的干预框架 发展，以：（1）发展对患者，提供者和系统级障碍的深入了解， 通过对患者进行半结构化访谈，促进适当的PPI胃保护， 提供者和其他关键信息提供者;（2）设计和制作基于理论的多层次干预， 目标患者，供应商和卫生系统;（3）评估的可行性，适当性，和有效性， 多层次干预在一个单一的网站试点研究。该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 多元干预。培训目标：Kurlander博士将在以下方面发展专业知识：（1）定性 研究方法，以了解卫生保健提供的背景方面;（2）理论为基础，多层次 （3）多层次干预的评价与优化方法。他还 将接受负责任地开展研究的具体培训。库兰德博士的培训将得到支持 由经验丰富，跨学科的导师，先进的教学课程，并参与研究 和职业发展会议/研讨会在一个理想的培训环境。由于受指导的 从这个奖项的研究培训，博士Kurlander将成为一个独立的调查员，独特的技能， 设计和优化有效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.