INTEGRATING PALLIATIVE CARE WITH DISEASE MANAGEMENT TO IMPROVE OUTCOMES AMONG PATIENTS WITH ADVANCED HEART FAILURE: INTERVENTIONAL RESEARCH CAREER DEVELOPMENT

将姑息治疗与疾病管理相结合，改善晚期心力衰竭患者的预后：介入研究职业发展

• 批准号: 9162916
• 负责人: Dionysios Kavalieratos
• 金额: $ 13.18万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9162916
• 关键词: Academic Medical Centers; Address; Administrator; Advance Care Planning; Affect; American; Ants; Award; Behavior Therapy; Capital; Cardiac; Cardiology; Cardiopulmonary; Cardiovascular system; Caregivers; Caring; Certification; Chronic; Clinic; Clinical; Clinical Management; Clinical Oncology Supplement (K12); Clinical Research; Clinical Sciences; Communities; Complex; Consult; Data; Decision Making; Development; Development Plans; Disease Management; Doctor of Philosophy; Duct (organ) structure; Eligibility Determination; Emotional; Ensure; Environment; Epidemic; Ethics; Evaluation; Evidence based treatment; Family; Feedback; Foundations; Funding; Goals; Health; Health Care Research; Health Services; Healthcare; Healthcare Systems; Heart Diseases; Heart failure; Hospitals; Individual; Inpatients; Institutes; Internal Medicine; Intervention; Intervention Studies; Intervention Trial; Interview; K-Series Research Career Programs; Lead; Leadership; Learning; Life; Measures; Medical; Medical Research; Medical center; Medicine; Mentors; Mentorship; Methods; Mission; National Heart, Lung, and Blood Institute; Nurses; Office Nursing; Outcome; Outcome Study; Outcomes Research; Outpatients; Palliative Care; Palliative Medicine; Participant; Patient-Centered Nursing; Patients; Phase; Population; Pragmatic clinical trial; Preparation; Process; Provider; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Research; Research Personnel; Resources; SECTM1 gene; Science; Shipping; Ships; Societies; Source; Specialist; Stress; Structure; Symptoms; System; Testing; Time; Training; Translational Research; Universities; Work; abstracting; base; care burden; career; career development; chronic care model; clinically relevant; collaborative care; comparative effectiveness; compare effectiveness; cost; design; effectiveness research; effectiveness trial; evidence base; experience; frailty; health care quality; implementation science; improved; improved outcome; innovation; medical schools; medical specialties; meetings; novel; palliative; patient oriented; physical symptom; professor; programs; psychologic; psychological symptom; psychosocial; research and development; skills; symptom management; theories; treatment as usual

PROJECT SUMMARY/ABSTRACT Candidate. The purpose of this K01 mentored career development award is to support Dionysios Kavaliera- tos, Ph.D. in establishing a clinical research program that will improve patient, caregiver, and systems out- comes in advanced heart failure (HF) through the delivery of palliative care. His long-term goal is to become an independent health services researcher conducting patient-centered comparative effectiveness research to im- prove quality of life for individuals affected by serious cardiopulmonary illness. Through this K01, his short- term goal is to learn how to design and evaluate scalable and widely disseminable interventions to integrate palliative care principles into standard cardiac management of advanced HF. Specifically, Dr. Kavalieratos will strengthen his research expertise by way of four interrelated career development objectives: (1) to deepen his understanding of the clinical management of patients with HF and the state-of-the-science regarding palliative care interventions in HF; (2) to develop expertise in designing, conducting, and evaluating complex behavioral interventions; (3) to learn dissemination and implementation science theory and methods; and (4) to develop practical skills in the management, leadership, and ethics involved in clinical research. Mentoring and Environment. Supporting Dr. Kavalieratos's career development experience is an inten- tionally-designed mentoring team composed of renowned clinicians and researchers who have an outstanding track record of mentoring junior investigators. His Primary Mentors are: Robert M. Arnold, MD FAAHPM (ex- pertise: palliative care) and Bruce L. Rollman, MD MPH (comparative effectiveness trials of collaborative care interventions). His Secondary Mentors are: Marie Bakitas, DNSc FAAN (nurse-led palliative care interven- tions) and Jeffrey Teuteberg, MD (advanced HF). In addition, Dr. Kavalieratos has assembled a Career Adviso- ry Committee to evaluate his progress towards career independence, comprising: Larry A. Allen, MD (cardio- vascular outcomes research), David Bekelman, MD MPH (palliative care interventions in HF), and Morris Weinberger, PhD (pragmatic clinical trials). As an Assistant Professor of Medicine within the University of Pittsburgh's Division of General Internal Medicine, Dr. Kavalieratos will have full access to the resources, facili- ties, and institutional capital of the School of Medicine, its Clinical and Translational Science Institute, and the University of Pittsburgh Medical Center. The Division has a strong record of developing successful independent investigators; more than 30 of its investigators have held or do hold individual career development awards. Research. Background: Over 6 million Americans live with the physical, psychosocial, and healthcare burdens of HF. Palliative care, when provided by a palliative care specialist, has been demonstrated to alleviate many of these burdens. Unfortunately, the specialty palliative care workforce is so severely limited that specialty palliative care is neither a feasible or scalable strategy to meet the needs of a growing HF population. As such, there is a critical need for innovative solutions to integrate palliative care into standard HF management, particularly for patients receiving care outside of major academic medical centers. This proposal focuses on “primary palliative care,” defined as basic palliative care delivered by clinicians without palliative care specialty training. Specific Aims: First, we will develop a patient-centered, nurse-led primary palliative care intervention for patients with advanced HF in outpatient cardiology clinics. With formative data generated in Dr. Kavalieratos's K12 award, we will develop a structured intervention using the Medical Research Council's Framework for De- velopment and Evaluation of RCTs for Complex Interventions. Second, we will conduct a pilot randomized con- trolled trial (RCT) of the intervention versus usual care to assess feasibility and fidelity. This intervention, based on the Chronic Care Model, will partner with an existing cardiology clinic nurse to deliver primary pallia- tive care, targeting the challenges and outcomes important to patients with HF and their caregivers. We will randomize 50 individuals with NYHA Class III/IV HF to the intervention or usual care. Third, we will refine the intervention by exploring its acceptability, barriers, facilitators, and mechanisms of action among patients, caregivers, and clinicians. Using the RE-AIM framework of intervention impact, we will conduct a rigorous mixed-methods evaluation of the intervention in preparation for a fully-powered comparative effectiveness tri- al. To ensure that this work is impactful, feasible, and sustainable, we have assembled an advisory board of patients, caregivers, clinicians, and administrators to provide input on all phases of this project, from interven- tion development through interpretation of results. The proposed research will provide Dr. Kavalieratos with the preliminary data, training, and experience to develop and lead a fully-powered R01-level pragmatic RCT to compare the effectiveness of primary palliative care versus usual HF care in patients with advanced HF be- ing cared for in community cardiology clinics. In turn, this award will contribute to Dr. Kavalieratos's devel- opment as a leader within the cardiopulmonary outcomes research community as he will develop, test, then deploy clinically-relevant, patient-centered strategies to promote the provision of palliative care, thereby im- proving patient, caregiver, and systems outcomes.

项目摘要/摘要 候选人。该K01修订职业发展奖的目的是支持Dionysios Kavaliera- TOS，博士在建立一项临床研究计划时，将改善患者，照顾者和系统以外 通过提供姑息治疗，它具有晚期心力衰竭（HF）。他的长期目标是成为一个 独立卫生服务研究人员进行以患者为中心的比较有效性研究 证明患有严重心肺疾病影响的人的生活质量。通过这个K01，他的短暂 术语目标是学习如何设计和评估可扩展且可广泛的干预措施以整合 姑息治疗原则纳入高级HF的标准心脏管理。特别是，Kavalieratos博士将 通过四个相互关联的职业发展目标来增强他的研究专业知识：（1）加深他 了解HF患者的临床管理以及有关姑息治疗的最新水平 HF的护理干预措施； （2）发展设计，进行和评估复杂行为方面的专业知识 干预措施； （3）学习传播和实施科学理论和方法； （4）发展 临床研究中涉及的管理，领导和道德方面的实践技能。 指导和环境。支持Kavalieratos博士的职业发展经验是一种强度 由著名的临床医生和研究人员组成的精心设计的指导团队，他们拥有出色的 心理初级调查人员的记录。他的主要导师是：罗伯特·M·阿诺德（Robert M. Arnold），医学博士Faahpm（Ex- 有关：姑息治疗）和MD MPH的Bruce L. Rollman（合作护理的比较有效性试验 干预措施）。他的次要导师是：玛丽·巴基塔斯（Marie Bakitas），dnsc faan（由护士领导的姑息治疗中间 Tions）和医学博士Jeffrey Teuteberg（高级HF）。此外，Kavalieratos博士还召集了职业咨询 RY委员会评估他在职业独立方面的进步，完成：MD Larry A. Allen（Cardio- 血管结果研究），David Bekelman，MD MPH（HF中的姑息治疗干预措施）和Morris Weinberger，博士（务实的临床试验）。作为大学内的医学助理教授 匹兹堡一般内科医学司卡瓦利埃拉托斯博士将完全访问资源 联系和医学院的机构首都，其临床和转化科学研究所以及 匹兹堡大学医学中心。该部门具有建立成功独立的有力记录 调查人员；其30多个调查人员已持有或持有个人职业发展奖。 研究。 背景：超过600万的美国人生活在HF的身体，社会心理和医疗保健伯伦斯。 姑息治疗在由姑息治疗专家提供时，已被证明可以减轻其中的许多 伯恩斯。不幸的是，专业的姑息治疗工作人员受到严格限制，以至于专业姑息治疗 护理既不是可行的或可扩展的策略，可以满足不断增长的HF人群的需求。因此，有一个 对创新解决方案的批判性需求将姑息治疗整合到标准的HF管理中，特别是对于 在主要学术医疗中心之外接受护理的患者。该提案的重点是“主要姑息 护理，”定义为临床医生在没有姑息治疗专业培训的情况下提供的基本姑息治疗。 具体目的：首先，我们将开发以患者为中心的，由护士主导的主要姑息治疗干预措施 门诊心脏病学诊所的晚期HF患者。带有Kavalieratos博士的形成性数据 K12奖，我们将使用医学研究委员会的框架进行结构化干预措施 复杂干预措施的RCT的速度和评估。其次，我们将进行一场飞行员随机分解 干预措施与常规护理评估可行性和忠诚度的巨魔试验（RCT）。这种干预措施， 基于慢性护理模型，将与现有心脏病学诊所护士合作，以提供主要的pallia- 护理，针对HF患者及其护理人员重要的挑战和结果。我们将 将50个NYHA III/IV级HF的人随机进行干预或通常的护理。第三，我们将完善 通过探索患者之间的可接受性，障碍，促进因子和作用机制来进行干预， 护理人员和临床医生。使用Re-AIM的干预影响框架，我们将进行严格的 对干预措施的混合方法评估，以准备完全供电的比较有效性三 al。为了确保这项工作具有影响力，可行和可持续性，我们组建了一个咨询委员会 患者，看护人，临床医生和管理人员提供该项目所有阶段的意见，从中间 通过解释结果的发展。拟议的研究将为Kavalieratos博士提供 初步数据，培训和经验，以开发和领导完全动力的R01级务实的RCT 比较初级姑息治疗与常规HF护理对晚期HF患者的有效性 在社区心脏病学诊所进行护理。反过来，该奖项将为Kavalieratos博士的Devel- 在他将开发，测试时，作为心肺成果研究社区的领导者的选择 部署与临床相关的，以患者为中心的策略来促进姑息治疗的提供，从而 证明患者，护理人员和系统成果。