Adaptation and Implementation of Clinical Practice Guidelines to Improve Stroke Outcomes in Zambia

调整和实施临床实践指南以改善赞比亚中风结果

• 批准号: 10369253
• 负责人: DEANNA Rae Saylor
• 金额: $ 18.75万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10369253
• 关键词: Achievement; Acute; Address; Adopted; Adult; Africa South of the Sahara; Age; Alteplase; Area; Attention; Award; Biological; Biology; Caregivers; Caring; Cause of Death; Cessation of life; Clinical Practice Guideline; Clinical Research; Cohort Studies; Collaborations; Communities; Country; Data; Dependence; Development; Enrollment; Focus Groups; Future; Goals; Guideline Adherence; Guidelines; HIV; Health Personnel; Health system; Hospital Referrals; Hospitals; Income; Inpatients; Institutes; International; Intervention; Interview; Knowledge; Literature; Maps; Measures; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; Neurologic; Neurology; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Population Heterogeneity; Positioning Attribute; Prevalence; Process; Prospective cohort; Provider; Research; Research Methodology; Research Personnel; Research Training; Resources; Rheumatic Heart Disease; Risk Factors; Secondary to; Services; Southern Africa; Specialist; Standardization; Stroke; System; Systems Development; Teaching Hospitals; Time; Training; Training Programs; Universities; Work; Working stroke; Zambia; acute stroke; base; care delivery; care systems; clinical care; clinical implementation; clinical practice; clinical trial implementation; clinically relevant; cohort; contextual factors; design; disability; effectiveness trial; epidemiology study; evidence base; experience; functional outcomes; global health; implementation framework; implementation process; implementation research; implementation science; improved; improved outcome; inpatient service; low and middle-income countries; medical schools; mortality; nervous system disorder; neuroimaging; post intervention; primary outcome; professor; programs; secondary outcome; skills; stroke intervention; stroke outcome; stroke patient; treatment strategy; uptake; working group

PROJECT SUMMARY The goal of this K01 application is to provide an individualized program of mentored research training for Dr. Deanna Saylor, an Assistant Professor in the Department of Neurology at the Johns Hopkins University School of Medicine. Dr. Saylor has been based full-time in Zambia since 2018 where, in collaboration with local stakeholders, she has launched the first neurology inpatient unit and first neurology post-graduate training program in the country. Dr. Saylor is applying for an International Research Scientist Development Award to gain skills and experience in implementation science research. Combined with her background in clinical and epidemiological research, this new skillset will uniquely position her to both generate new knowledge and help develop care systems that effectively implement new knowledge to improve patient outcomes. The research plan outlined in this application leverages the developing system of neurological care in Zambia to understand current stroke care practices at the University Teaching Hospital (UTH; Zambia's national referral hospital), develop locally relevant stroke clinical practice guidelines, and examine the effect of their implementation on stroke outcomes. Since stroke is the second leading cause of adult disability and mortality worldwide and stroke prevalence in sub-Saharan Africa is amongst the highest in the world, these data are urgently needed to address this national, regional, and global health problem. The proposed research includes a pre-intervention prospective cohort of patients with stroke at UTH to characterize current stroke care clinical practices and stroke outcomes (aim 1). A stroke working group including relevant stakeholders will then be convened to investigate community, patient, provider, and health systems factors leading to difficulty achieving stroke quality measures and optimal outcomes. The Adopt-Contextualize-Adapt framework will then be used to develop locally relevant clinical practice guidelines from international stroke guidelines for implementation (aim 2). These guidelines will then be implemented, and a post-intervention observational cohort study conducted to examine their impact on achieving stroke quality measures and improving stroke outcomes. This K01 will also support Dr. Saylor's training goals which include gaining additional training and mentorship in the following key areas: (1) implementation science frameworks and methodology; (2) qualitative data methods and analysis; (3) stroke clinical research methods, especially aspects unique to global settings; and (4) developing an international network of collaborators for future large-scale and generalizability studies. In order to achieve these goals, Dr. Saylor has established an international team of mentors with expertise in implementation science, qualitative studies, stroke research, neurology research in sub-Saharan Africa, and stroke center development in international settings. This award will provide Dr. Saylor with the mentorship, knowledge, and experience necessary to become an independent investigator in global neurology conducting clinical and implementation research to improve outcomes for patients with stroke and other neurologic disorders.

项目概要 该 K01 应用程序的目标是为 Dr. 提供个性化的指导研究培训计划。 Deanna Saylor，约翰霍普金斯大学神经病学系助理教授 医学。 Saylor 博士自 2018 年以来一直在赞比亚全职工作，与当地机构合作 她发起了第一个神经病学住院病房和第一个神经病学研究生培训 计划在该国。 Saylor 博士正在申请国际研究科学家发展奖 获得实施科学研究的技能和经验。结合她的临床和背景 流行病学研究，这一新技能将使她能够独特地产生新知识并提供帮助 开发有效应用新知识以改善患者治疗效果的护理系统。研究 本申请中概述的计划利用赞比亚正在发展的神经护理系统来了解 大学教学医院（UTH；赞比亚国家转诊医院）当前的中风护理实践， 制定当地相关的卒中临床实践指南，并检查其实施对患者的影响 中风结果。由于中风是全世界成人残疾和死亡的第二大原因， 撒哈拉以南非洲地区的中风患病率是世界上最高的，迫切需要这些数据来 解决这一国家、区域和全球健康问题。拟议的研究包括预干预 UTH 中风患者的前瞻性队列，以描述当前中风护理临床实践的特点， 卒中结果（目标 1）。随后将召集包括相关利益相关者在内的中风工作组，以 调查导致中风困难的社区、患者、提供者和卫生系统因素 质量措施和最佳结果。然后，Adopt-Contextualize-Adapt 框架将用于 根据国际卒中指南制定本地相关的临床实践指南以供实施（目标 2）。然后将实施这些指南，并进行干预后观察队列研究 检查它们对实现卒中质量测量和改善卒中结果的影响。这款K01将 还支持 Saylor 博士的培训目标，其中包括在以下方面获得额外的培训和指导 关键领域：（1）实施科学框架和方法； (2) 定性数据方法和 分析; (3) 卒中临床研究方法，特别是全球独有的方面； (4) 发展 未来大规模和普遍性研究的国际合作者网络。为了达到 为了实现这些目标，塞勒博士建立了一支由具有实施方面专业知识的国际导师团队 科学、定性研究、中风研究、撒哈拉以南非洲的神经病学研究和中风中心 国际环境下的发展。该奖项将为 Saylor 博士提供指导、知识和 成为全球神经病学独立研究者进行临床和临床研究所必需的经验 实施研究以改善中风和其他神经系统疾病患者的治疗结果。