Optimizing care for older surgical patients: atheory-guided implementation science approach

项目总结/摘要 这个NIA保罗B。Beeson K76新兴领导者职业发展提案将为Cizginer博士提供 传播和实施（D&I）科学的关键技能，并支持她的发展， 独立研究员和老年外科的领导者。她的具体培训目标包括：1）获得D&I 科学和定性研究专业知识，2）临床试验设计和混合方法数据培训 整合，并进行混合实施效果试验的循证实践，在老年医学 外科手术，和3）先进的领导培训。老年人占所有住院手术的40%， 患者的发病率和死亡率是年轻患者的两倍。考虑到预测的指数 随着老年人口的增加，迫切需要使住院手术更安全。为了应对这一紧迫 需要，美国外科医生学会（ACS）老年外科手术验证（GSV）计划最近 引入了30项循证标准，旨在系统地改善手术护理和结果。 然而，在支持将这些标准纳入日常实践方面，缺乏有针对性的努力。 因此，本提案旨在解决关于传播和传播信息的最佳方式方面的知识差距， 实施GSV计划，以改善老年手术患者的结局。这一目标将在 以下目标：目标1将确定ACS GSV计划注册的障碍和促进因素;目标2 将制定实施战略并解决GSV计划实施的障碍;目标3将是 在当地一家医院进行试点实施试验，以测试克服障碍的战略的有效性， GSV实施，将生成数据以支持R 01提案。Cizginer博士是唯一有资格 领导这项工作，因为（1）她是布朗大学老年外科的医学主任， 实施和评估一个综合的老年外科手术模式，（2）有以前的临床研究 有超过20篇同行评审文章的经验，（3）在流行病学和卫生服务方面受过正式培训 研究和（4）缺乏D&I科学（新的研究兴趣）的正式培训和研究经验。 最终，这项工作将为Cizginer博士开展独立研究事业铺平道路， 创造新颖和有价值的策略，将循证实践纳入常规临床实践， 老年手术患者，减少相关的医疗保健成本和改善患者的结果。

PROJECT SUMMARY/ABSTRACT This NIA Paul B. Beeson K76 Emerging Leaders Career Development proposal will provide Dr. Cizginer with critical skills in dissemination and implementation (D&I) science and support her development as an independent researcher and leader in geriatric surgery. Her specific training goals include 1) gaining D&I science and qualitative research expertise, 2) training in clinical trial design and mixed methods data integration, and conducting a hybrid implementation-effectiveness trial for evidence-based practices in geriatric surgery, and 3) advanced leadership training. Older adults make up 40% of all inpatient surgeries, and those patients experience twice the morbidity and mortality of younger patients. Given the projected exponential increase in geriatric population, there is an urgency to make inpatient surgery safer. In response to this urgent need, the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program recently introduced 30 evidence-based standards designed to systematically improve surgical care and outcomes. However, there is a paucity of focused efforts to support the uptake of these standards into routine practice. Thus, this proposal aims to address the knowledge gap regarding the optimal ways to disseminate and implement the GSV program to improve outcomes of older surgical patients. This goal will be met in the following aims: Aim 1 will identify the barriers and facilitators for enrollment to the ACS GSV program; Aim 2 will create implementation strategies and address barriers to GSV Program implementation; and Aim 3 will be a pilot implementation trial in a local hospital to test the effectiveness of the strategies to overcome barriers for GSV implementation, which will generate data to support an R01 proposal. Dr. Cizginer is uniquely qualified to lead this effort as (1) she is the Medical Director of Geriatric Surgery at Brown and has experience implementing and evaluating an integrated geriatric surgery model, (2) has previous clinical research experience with over 20 peer-reviewed articles, (3) has formal training in epidemiology and health services research and (4) lacks formal training and research experience in D&I science (new research interest). Ultimately, this work will pave the way for Dr. Cizginer to launch her independent research career while creating novel and valuable strategies to implement evidence-based practices into routine clinical practice for geriatric surgery patients, reducing related health care costs and improving patient outcomes.