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.

项目概要/摘要 候选人。K01 指导职业发展奖的目的是支持 Dionysios Kavaliera- tos 博士建立了一个临床研究项目，该项目将改善患者、护理人员和系统的输出 通过提供姑息治疗患上晚期心力衰竭 (HF)。他的长期目标是成为一名心力衰竭患者。 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 通过这个 K01，他的短期成果证明了患有严重心肺疾病的人的生活质量。 术语目标是学习如何设计和评估可扩展且可广泛传播的干预措施以整合 具体来说，Kavalieratos 博士将把姑息治疗原则纳入晚期心力衰竭的标准心脏管理中。 通过四个相互关联的职业发展目标来加强他的研究专业知识：（1）加深他的研究专业知识 了解心力衰竭患者的临床管理以及姑息治疗的最新进展 心力衰竭的护理干预措施；(2) 发展设计、实施和评估复杂行为的专业知识 干预措施；(3) 学习传播和实施科学理论和方法；(4) 发展 临床研究涉及的管理、领导和道德方面的实践技能。 支持 Kavalieratos 博士的职业发展经验是一个重点。 精心设计的导师团队，由拥有杰出研究成果的知名巨星和研究人员组成 他的主要导师是：Robert M. Arnold，医学博士 FAAHPM（前任） pertise：姑息治疗）和 Bruce L. Rollman，MD MPH（协作护理的比较有效性试验） 他的二级导师是：Marie Bakitas，DNSc FAAN（护士主导的姑息治疗干预）。 系统蒸发散）和 Jeffrey Teuteberg，医学博士（高级 HF）此外，Kavalieratos 博士还编写了一份职业建议。 委员会评估他在职业独立方面的进展，包括：拉里·艾伦 (Larry A. Allen)，医学博士（心脏科 血管结果研究），David Bekelman，MD MPH（心力衰竭的姑息治疗干预）和 Morris Weinberger，博士（实用临床试验），担任大学医学助理教授。 匹兹堡普通内科医学部的 Kavalieratos 博士将能够充分利用这些资源， 医学院及其临床和转化科学研究所以及 匹兹堡大学医学中心拥有成功发展独立机构的良好记录。 调查员；超过 30 名调查员曾获得或确实获得过个人职业发展奖。 研究。 背景：超过 600 万美国人承受着心力衰竭的身体、心理和医疗负担。 姑息治疗由姑息治疗专家提供，已被证明可以缓解其中的许多问题 不幸的是，专业姑息治疗的劳动力非常有限，以至于专业姑息治疗的负担。 护理既不是满足不断增长的心力衰竭人群需求的可行或可扩展的策略，也不是一种可行的或可扩展的策略。 迫切需要创新解决方案将姑息治疗纳入标准心力衰竭管理，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“初级姑息治疗”。 护理”定义为未经姑息治疗专业培训的教区居民提供的基本姑息治疗。 具体目标：首先，我们将为患者制定以患者为中心、护士主导的初级姑息治疗干预措施 心脏病门诊中的晚期心力衰竭患者，由 Kavalieratos 博士生成的形成性数据。 K12 奖，我们将利用医学研究委员会的框架开发结构化干预措施 复杂干预措施的随机对照试验的开发和评估 其次，我们将进行一项随机试验试点。 干预与常规护理的对照试验（RCT），以评估这种干预的可行性和保真度。 基于慢性护理模式，将与现有的心脏病诊所护士合作，提供初级帕利亚- 我们将针对心力衰竭患者及其护理人员的重要挑战和结果提供积极的护理。 将 50 名 NYHA III/IV 级心力衰竭患者随机分组，接受干预或常规护理。 第三，我们将改进。 通过探索患者的可接受性、障碍、促进因素和作用机制来进行干预， 我们将利用 RE-AIM 干预影响框架，对护理人员和退伍军人进行严格的调查。 对干预措施进行混合方法评估，为充分有力的比较有效性三项准备工作做好准备 为了确保这项工作具有影响力、可行和可持续，我们组建了一个顾问委员会 患者、护理人员、顾客和管理人员就该项目的所有阶段提供意见，从干预到 拟议的研究将为 Kavalieratos 博士提供帮助。 开发和领导功能齐全的 R01 级实用 RCT 的初步数据、培训和经验 比较初级姑息治疗与常规心力衰竭治疗对晚期心力衰竭患者的有效性 反过来，该奖项将有助于 Kavalieratos 博士的发展。 作为心肺结果研究界的领导者，他将开发、测试，然后 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，从而改善 证明患者、护理人员和系统的结果。