Shared Decision-Making to Improve the Health Status of Patients with Claudication: Developing and Implementing Strategies to Individualize Treatment Decisions

共同决策以改善跛行患者的健康状况：制定和实施个性化治疗决策的策略

• 批准号: 10222775
• 负责人: Eric Alexander Secemsky
• 金额: $ 17.03万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10222775
• 关键词: Address; Advisory Committees; Affect; African American; Aftercare; American; Applications Grants; Arteries; Award; Belief; Benefits and Risks; Biometry; Biostatistical Methods; Blood Vessels; Cardiology; Cardiovascular system; Caring; Classification; Clinic; Clinical; Clinical Investigator; Clinical Research; Conflict (Psychology); Consultations; Data; Decision Aid; Decision Making; Development; Diagnostic; Elements; Ensure; Environment; Evaluation; Evidence based treatment; Exercise; Face; Future; Goals; Health Care Costs; Health Expenditures; Health Status; Hemorrhage; Heterogeneity; Individual; Intervention; Interview; Kidney Failure; Knowledge; Lead; Leg; Location; Lower Extremity; Measurement; Measures; Medical; Medicine; Mental Depression; Mentors; Mentorship; Methods; Modeling; Multicenter Trials; Nurse Administrator; Outcome; Outcomes Research; Outpatients; Pain; Patient Care; Patient Outcomes Assessments; Patient Preferences; Patient-Focused Outcomes; Patients; Peripheral; Peripheral arterial disease; Physicians; Pilot Projects; Predictive Factor; Procedures; Process; Program Development; Provider; Qualitative Methods; Qualitative Research; Quality of Care; Quality of life; Questionnaires; Race; Readiness; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Science; Scientist; Selection for Treatments; Structure; Supervision; Symptoms; Testing; Therapeutic; Treatment outcome; Uncertainty; Woman; Work; care outcomes; career; career development; claudication; clinical care; clinical practice; comparison intervention; cost; design; experience; health care service utilization; implementation science; implementation strategy; improved; individual patient; individualized medicine; intervention cost; medical specialties; men; novel; practice setting; preference; prospective; response; shared decision making; skills; statistics; symptomatic improvement; tool; treatment as usual; treatment choice; treatment strategy

PROJECT SUMMARY/ABSTRACT Peripheral artery disease (PAD) affects up to 12 million Americans and accounts for healthcare expenditures totaling $21 billion annually. Invasive procedures, one of multiple therapies available to improve PAD symptoms, are increasingly being used, but are costly, may cause complications, and do not benefit all patients equally. Furthermore, selecting a PAD treatment strategy requires aligning patient preferences with the risks and benefits of therapies available to them. However, PAD care is fragmented across clinical settings and specialties, resulting in variable approaches in eliciting patient preferences and presenting treatment choices. These combined factors make implementation of shared decision-making in PAD care an urgent yet challenging endeavor. This proposal seeks to address this issue using a multi-faceted approach. In Aim 1, we will use prospective patient-level data to build and rigorously validate models that prognosticate 1- year health status and estimate responses to different therapeutic strategies (medical therapy, supervised exercise and vascular intervention). These tools will be used to individualize treatment with a focus on outcomes that are meaningful to the patient. In Aim 2, we will conduct semi-structured interviews and use a formative diagnostic tool to evaluate vascular stakeholders' beliefs, concerns, and challenges related to shared decision-making. These interviews will then be used to design practical implementation strategies. In Aim 3, we will perform a pilot study of 50 patients with claudication to evaluate the impact of an established PAD decision aid on measures of decision quality and knowledge. This study will provide preliminary data for a larger, multicenter trial evaluating how the aid can be applied to improve decision-making, health status, and long-term outcomes for patients with claudication. The overarching goal of this proposal is to promote informed, evidence-based treatment decisions among patients with claudication in order to improve quality of care and outcomes, and reduce healthcare utilization and costs. The first two aims of the proposal will provide the necessary evidence and resources to introduce shared decision-making into the vascular clinic. The third aim will evaluate the direct influence of a decision aid specific to PAD on the quality of treatment decisions. This research will be accomplished in the setting of a comprehensive career development program designed to provide Dr. Secemsky, an early career investigator and interventional cardiologist, with the skills needed to become an independent physician-scientist. His long-term career goal is to ensure that cardiovascular patients who face important medical decisions are meaningfully engaged, well informed, and receive treatments that match their preferences and goals. Over the course of the award period, Dr. Secemsky will be guided in his transition to independence by an outstanding mentoring team and advisory committee of established clinical investigators with expertise in cardiovascular medicine, outcomes research, advanced biostatistical and qualitative methods, shared decision-making, and implementation science.

项目摘要/摘要 外围动脉疾病（PAD）影响多达1200万美国人，并占医疗支出 每年总计210亿美元。侵入性程序，一种可改善PAD的多种疗法之一 症状越来越多地被使用，但昂贵，可能会引起并发症，并且不会使所有人受益 患者平等。此外，选择PAD治疗策略需要将患者的喜好与 他们可以使用的疗法的风险和好处。但是，PAD护理在临床上分散 设置和专业，导致引起患者偏好并提出的可变方法 治疗选择。这些综合因素使得在PAD护理中实施共同决策 紧急但充满挑战的努力。该提案旨在使用多方面的方法来解决此问题。在 AIM 1，我们将使用预期的患者级数据来构建和严格验证预测1-的模型 年份健康状况并估算对不同治疗策略的反应（医疗疗法，监督 运动和血管干预）。这些工具将用于个性化治疗，重点 对患者有意义的结果。在AIM 2中，我们将进行半结构化访谈，并使用 评估血管利益相关者的信念，关注和挑战的形成性诊断工具 共同的决策。然后，这些访谈将用于设计实施策略。在 AIM 3，我们将对50名具有laurauration的患者进行试点研究，以评估已建立的影响 对决策质量和知识的衡量标准决策援助。这项研究将为 一项更大的多中心试验，评估如何应用援助来改善决策，健康状况， 和lau不平患者的长期结局。该提议的总体目标是促进 知情的，基于证据的治疗决策，以提高 照顾和结果，并降低医疗保健利用和成本。提案的前两个目标将 提供必要的证据和资源，将共同决策引入血管诊所。 第三个目标将评估专门针对治疗质量的决策援助的直接影响 决定。这项研究将在综合职业发展计划的设置中完成 旨在为早期职业研究员和介入心脏病专家Secemsky博士提供技能 需要成为独立的医师科学家。他的长期职业目标是确保 面临重要医疗决定的心血管血管疾病患者有意义地参与，知情和 接受与他们的偏好和目标相匹配的治疗方法。在整个奖项期间，博士 杰出的指导团队和咨询 成熟临床研究人员委员会具有心血管医学专业知识，成果研究， 先进的生物统计和定性方法，共同的决策和实施科学。