Patient-centered approaches to diagnosing coronary heart disease

以患者为中心的冠心病诊断方法

基本信息

批准号：
8885509
负责人：
Joseph Abiodun Ladapo
金额：
$ 14.74万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2016-06-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8885509
关键词：
Accounting Address Aging American American Heart Association Anxiety Area Arts Bayesian Modeling Belief Businesses Calibration Cardiac Catheterization Procedures Cardiology Caring Characteristics Chronic Disease Climacteric Clinic Clinical Clinical Informatics Clinical Management Clinical Research Computer Simulation Coronary Coronary heart disease Data Decision Analysis Decision Making Development Diagnosis Diagnostic Diagnostic tests Disease Doctor of Philosophy Education Educational workshop Electronic Health Record Elements Enrollment Epidemiology Evaluation Failure Focus Groups Foundations Goals Guidelines Health Health Policy Health behavior Health system Heart Diseases Human Development Image Individual Institute of Medicine (U.S.)Interview Joints Longevity Measures Medical Medical center Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Mission Modeling National Heart, Lung, and Blood Institute New York Patient Care Patient Preferences Patients Pattern Performance Physicians Positive Test Result Prevention Procedures Public Health Publishing Qualitative Methods Quality of life Radiation Research Research Personnel Research Training Risk Schools Science Societies Stress Tests Supervision Surveys Survival Analysis Techniques Technology Test Result Testing Time Training Translating Uncertainty Universities Validation Work career career development clinical decision-making college diagnostic accuracy epidemiological model experience follow-up illness perceptions improved informatics training interest medical schools novel diagnostics patient oriented patient population performance tests preference public health relevance screening skills tool

项目摘要

DESCRIPTION (provided by applicant): I, Joseph A. Ladapo, MD, PhD, am a physician and health policy researcher who is passionately committed to pursuing a meaningful career in clinical research by translating research findings into better care for patients. The NHLBI K23 Mentored Patient-Oriented Research Career Development Award will provide me with the additional training I need to achieve this goal, thus maximizing my contribution to patients' lives I completed a PhD in Health Policy during medical school and my primary research interest relates to the use of clinical decision-analysis to improve the care of patients evaluated and treated for coronary heart disease (CHD) and other chronic diseases. My interest in this area has grown out of my own personal experience with diagnostic uncertainty and also from my experience caring for patients evaluated for new, life-changing diseases. I have published prior studies in this area, some of which has been cited in clinical guidelines issued by the American College of Cardiology and the American Heart Association. The specific aims of this proposal involve developing patient-centered approaches to diagnosing CHD that improve diagnostic accuracy, reduce unnecessary testing and radiation exposure, and incorporate the impact of false-positive stress test results on patients' anxiety, perception of illness, and quality of life These aims significantly extend prior work in this area and involve (1) primary analyses of electronic health records from Geisinger Health System that inform clinical and demographic characteristics of this patient population; (2) development of epidemiological models of follow-up management and Bayesian models of diagnostic test performance that adjust for verification bias (this has not previously been done in this type of work); (3) qualitative interviews of patiens in focus groups to better understand the impact of false-positive test results on quality of life, followed by survey research informed by these interviews; and (4) development of a clinical decision-analysis model that combines all of the above elements and informs optimal approaches to evaluation and treatment. [The overall hypothesis that drives my work is the belief that patient-centered approaches to diagnosing CHD can improve diagnostic accuracy while reducing patient harms. The clinical decision-analysis model I propose to build in Aim 3 will permit formal evaluation of this hypothesis.] With the supervision and mentorship of Scott Braithwaite, MD, MSc (primary mentor), Judith Hochman, MD (co-mentor), Donna Shelley, MD (co-mentor), David Carey, PhD (co-mentor), Gbenga Ogedegbe, MD, MS, MPH, FACP (co-mentor), and Pamela Douglas, MD (advisor); participation in seminars and workshops at New York University (NYU); and formal coursework, I will receive the training I need to develop into an independent investigator. The specific methodological skills that will enable me to complete my training and research objectives constitute a combination of quantitative and qualitative training, including epidemiological training in survival analysis, clinical informatics training to leverage the powerful tool of EHR for research, qualitative methods in the performance and analysis of patient focus groups, and survey research. I will also benefit from additional training in advanced clinical decision-analysis, computer modeling techniques, model calibration, and validation. My coursework will be completed at NYU's Graduate School of Arts and Science; Steinhardt School of Culture, Education, and Human Development; Stern School of Business; and the School of Medicine. My career goals are consistent with NHLBI's mission to promote the prevention and treatment of heart disease and enhance the health of all individuals, and I have a highly supportive team of mentors to supervise and direct my training. I believe the K23 will provide me with the training and mentorship I need to develop into an independent investigator.

描述（由申请人提供）：I，Joseph A. Ladapo，医学博士，博士学位，是一名医生和健康政策研究人员，他热情地致力于通过将研究发现转化为对患者的更好护理，从而从事有意义的临床研究职业。 NHLBI K23指导了以患者为导向的研究职业发展奖，将为我提供实现这一目标所需的额外培训，从而最大程度地提高了我对患者生活的贡献，我在医学院期间完成了卫生政策博士学位，而我的主要研究兴趣与临床决策的使用有关，与临床决策分析有关改善对患者的护理和治疗冠状心脏病（CHD）和其他Chronic（Chd）和其他Chronic症和其他CHRONICSES和其他疾病。我对这一领域的兴趣已经超出了我自己对诊断不确定性的个人经验，也是我照顾评估新的，改变生活的疾病的患者的经验。我已经在该领域发表了先前的研究，其中一些是在美国心脏病学院和美国心脏协会发布的临床指南中引用的。该提案的具体目的涉及开发以患者为中心的方法来诊断CHD，以提高诊断准确性，减少不必要的测试和辐射暴露，并纳入虚假阳性压力测试结果对患者焦虑，疾病感知和生活质量的焦虑和生活质量的影响。（2）开发随访管理的流行病学模型和调整验证偏差的诊断测试性能模型（以前在此类工作中尚未完成）；（3）对焦点小组中patiens的定性访谈，以更好地了解假阳性测试结果对生活质量的影响，其次是通过这些访谈的调查研究；（4）开发结合上述所有要素的临床决策分析模型，并为评估和治疗的最佳方法提供了信息。 [驱动我工作的总体假设是，以患者为中心的诊断CHD的方法可以提高诊断准确性，同时减少患者的伤害。我建议在目标3中建立的临床决策分析模型，将允许对该假设进行正式评估。（Co-entor）和医学博士Pamela Douglas（顾问）；参加纽约大学（纽约大学）的研讨会和研讨会；和正式的课程工作，我将收到我为独立调查员开发的培训。使我能够完成培训和研究目标的具体方法学技能构成了定量和定性培训的结合，包括生存分析中的流行病学培训，临床信息学培训利用EHR的强大工具进行研究，在患者焦点小组的性能和分析中的定性方法以及调查研究。我也将从其他培训中受益在高级临床决策分析中，计算机建模技术，模型校准和验证。我的课程将在纽约大学艺术与科学研究生院完成；斯坦哈特文化，教育和人类发展学院；斯特恩商学院；和医学院。我的职业目标与NHLBI促进心脏病的预防和治疗并增强所有人的健康的使命是一致的，我拥有一支高度支持的导师团队来监督和指导我的培训。我相信K23将为我提供为独立调查员发展所需的培训和指导。