Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK)

喀拉拉邦急性冠状动脉综合征质量改善 (ACS QUIK)

• 批准号: 8242535
• 负责人: Mark D Huffman
• 金额: $ 9万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8242535
• 关键词: Academic Detailing; Acute; Admission activity; Adrenergic beta-Antagonists; Age; Americas; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Award; Cardiology; Cardiovascular system; Caring; Cause of Death; Cessation of life; Clinical; Clinical Pathways; Clinical Trials Design; Cognitive; Complement; Control Groups; Coronary heart disease; Country; Data; Data Collection; Development; Diet; Disease; Economic Policy; Education; Educational workshop; Epidemiologic Studies; Evaluation; Event; Exercise; Family; Federal Government; Focus Groups; Foundations; Goals; Government; Guidelines; Health Personnel; Health Status; Healthcare Systems; Heart; Heart Arrest; Hemorrhage; Heparin; Hospitalization; Hospitals; Household; Income; India; Individual; Inpatients; Institutes; Insurance; International; Interview; Knowledge; Language; Lead; Learning; Life Style; Measures; Mentorship; Mission; Modeling; Myocardial Infarction; National Heart, Lung, and Blood Institute; Outcome; Participant; Patients; Perception; Performance; Pharmaceutical Preparations; Platelet Glycoprotein GPIIb-IIIa Complex; Poverty; Program Evaluation; Provider; Public Health; Qualitative Research; Quality of Care; Quality of life; Questionnaires; Randomized; Recurrence; Registries; Research Ethics; Research Infrastructure; Solutions; Source; Stroke; Surveys; Symptoms; System; Tobacco Use Cessation; Training; Translating; United States; United States National Institutes of Health; acute coronary syndrome; base; burden of illness; cardiovascular disorder epidemiology; career development; clopidogrel; evidence base; follow-up; global health; group intervention; health economics; health training; implementation science; improved; innovation; member; novel; patient oriented; programs; research and development; satisfaction; tool; treatment as usual

DESCRIPTION (provided by applicant): The proposed application aims to develop, implement, and evaluate the impact of a quality improvement toolkit on 30-day major adverse cardiovascular event rates following acute coronary syndrome (ACS) through a cluster-randomized, stepped wedge clinical trial design in Kerala, India. System-level quality improvement initiatives in ACS, while successful in high-income countries, have not been extensively evaluated in low- and middle-income countries (LMIC), yet could be sources of innovation in the field of cardiovascular implementation science. This proposal will leverage the research infrastructure from the Kerala ACS Registry, which recently completed data collection from >25,000 ACS participants over the past 2 years. The proposal also contains 2 sub-studies that will evaluate the patient-level impact of ACS in Kerala, which may serve as a model for India and other LMIC. The first sub-study aims to evaluate coronary heart disease- specific quality of life following ACS using a linguistically-validated Seattle Angina Questionnaire (translated and validated from English to Malayalam, the local language of Kerala). The Seattle Angina Questionnaire surveys patients' physical limitations, symptoms, treatment satisfaction, and disease perception. The second sub-study aims to evaluate individual- and household-level impoverishing effects of an ACS event in the context of the recent implementation of a national government insurance program (Rashtriya Swathya Bima Yojna) for families below the poverty line. The proposal also includes an exploratory aim to perform qualitative research in toolkit development. This aim will incorporate focus group discussions among quality improvement team members to determine facilitators and barriers to optimal ACS care in the development of locally- developed provider-related toolkit components (clinical pathways, admission/discharge checklists, e.g.) as well as cognitive interviews with patients in the development of patient-related toolkit components (discharge education/information materials). During the career development period of this award, I will pursue patient-centered ACS registry training at St. Luke's/Mid-America Heart Institute under Dr. John Spertus, a national leader in the field. I will take courses in research ethics, program evaluation, and health economics to complement my prior training. I will participate in training workshops/pilots with Dr. Kalipso Chalkidou through NICE International, a division of the UK National Institute for Health and Clinical Excellence (NICE), to learn about the development of evidence- informed, clinical standards and guidelines adapted to local country settings and healthcare systems. I have a unique combination of public health, cardiology, and Fogarty global health training and cardiovascular epidemiology research in India that will provide a strong foundation for this project. The mentorship and advisory teams consist of US and Indian leaders in global cardiovascular epidemiology, public health, and quality care and outcomes, and will provide expert guidance for my career development and for the research itself. Relevance Development of local solutions to improving ACS care by Indian practitioners may provide innovative ideas that are relevant to and applicable in the US. As such, this proposal aims to improve the delivery of ACS care in India and capture the innovative potential of global health, a thematic goal of the NIH and part of the mission of the NHLBI.

描述（由申请人提供）：拟议的申请旨在通过急性冠状动脉综合征（ACS）在印度喀拉拉邦的急性冠状动脉综合征（ACS）之后开发，实施和评估质量改进工具包对急性冠状动脉综合征（ACS）后30天重大不良心血管事件的影响。 ACS的系统级质量改进计划虽然在高收入国家成功，但在低收入和中等收入国家（LMIC）中尚未得到广泛的评估，但可能是心血管实施科学领域的创新来源。该提案将利用喀拉拉邦ACS注册中心的研究基础设施，该研究基础设施最近从过去两年中完成了> 25,000 ACS参与者的数据收集。 该提案还包含2个子阶级，这些子团队将评估ACS在喀拉拉邦的患者级影响，这可能是印度和其他LMIC的模型。第一个子研究旨在使用语言验证的西雅图心绞痛调查表（从英语翻译和验证到喀拉拉邦的本地语言），评估ACS之后的冠状动脉疾病 - 特定的生活质量。西雅图心绞痛问卷调查患者的身体局限性，症状，治疗满意度和疾病感知。第二个子研究旨在评估ACS事件的个人和家庭级别的贫困效果，这是针对贫困线以下的家庭的最新实施（Rashtriya Swathya Bima Yojna）。该提案还包括探索性目的，以在工具包开发方面进行定性研究。该目标将在质量改进团队成员之间进行焦点小组的讨论，以确定与当地开发的提供商相关的工具包成分（临床途径，录取/出院清单，例如）以及与患者在与患者相关的工具套件开发中的认知访谈（例如，临床途径，入院/出院清单，例如临床途径，入学/出院清单，例如临床途径，入学/出院清单，例如临床途径，入院/出院清单），以确定最佳ACS护理的障碍和障碍。 在该奖项的职业发展期间，我将在该领域的国家领导者约翰·斯佩特斯（John Spertus）博士的领导下，在圣卢克/中美洲中心研究所接受以患者为中心的ACS登记培训。我将参加研究伦理，计划评估和健康经济学的课程，以补充我先前的培训。我将通过英国国家卫生与临床卓越研究所（NICE Institute of Nice International）（NICE International）与Kalipso Chalkidou博士一起培训研讨会/飞行员，以了解开发适合当地国家环境和医疗保健系统的证据知情，临床标准和指南。 我在印度的公共卫生，心脏病学和Fogarty全球健康培训和心血管流行病学研究方面拥有独特的结合，这将为该项目提供良好的基础。指导和咨询团队由美国和印度领导者组成，领域是全球心血管流行病学，公共卫生以及优质的护理和成果，并将为我的职业发展和研究本身提供专家指导。与印度从业人员改善ACS护理的当地解决方案的相关性可以提供与美国相关和适用的创新思想。因此，该提案旨在改善印度ACS护理的交付，并捕捉全球健康的创新潜力，NIH的主题目标和NHLBI任务的一部分。