SYNDICARE: Syncope Decision Aid for Emergency Care

SYNDICARE：晕厥紧急护理决策辅助

基本信息

批准号：
9265933
负责人：
Marc Probst
金额：
$ 16.96万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-05-01 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9265933
关键词：
Accident and Emergency department Acute Admission activity Adult Adverse event Applications Grants Area Benign Cardiac Cardiovascular system Caring Cessation of life Chest Clinical Clinical Investigator Clinical Management Clinical Trials Data Databases Decision Aid Development Development Plans Diagnostic Electrocardiogram Emergency Care Emergency Department Physician Emergency Department evaluation Emergency Department patient Emergency Situation Emergency department visit Etiology Event Feedback Funding Grant Healthcare Heart Diseases Hospital Costs Hospitalization Hospitals Hour International Intervention Interview Joints Knowledge Malignant - descriptor Measures Medical Mentors Mentorship Names National Heart, Lung, and Blood Institute Outcome Outpatients Paper Patient Care Patient-Focused Outcomes Patients Phase Physicians Principal Investigator Process Provider Qualitative Methods Quality of Care Randomized Randomized Controlled Trials Recruitment Activity Research Research Methodology Research Project Grants Research Proposals Risk Site Structure Surveys Syncope Testing Unconscious State United States Visit Work acute coronary syndrome arm base career development clinical practice control trial design evidence base experience follow-up implementation science improved neuroimaging older patient preference prototype public health relevance randomized trial satisfaction secondary outcome shared decision making skills structural heart disease tool treatment as usual usability

项目摘要

DESCRIPTION (provided by applicant): The objective of this career development plan and proposed research is to develop the principal investigator into an independent clinical investigator to improve the emergency care of syncope patients. Syncope, or transient loss of consciousness, is a common reason to seek emergency department (ED) care. It can be caused by serious cardiac disease but is often a result of a benign etiology. Despite decades of research in this area, there remains a huge variability in the clinical management of these patients. Hospitalization after a non-diagnostic ED evaluation has not been shown to benefit patients and may, in some cases, be harmful. This decision is often made without significant input from patients regarding their wishes or discussion of reasonable alternatives. Shared decision-making is a collaborative process in which patients and physicians make a health care decision together, taking into account the best available evidence and the patient's values and preferences. Shared decision-making is appropriate when more than one medically reasonable management options exists, as in out-patient versus in-patient management of low-risk syncope patients. Decision aids are tools designed to increase patient understanding of treatment options and possible outcomes. Another means to improve emergency syncope care is the application of dissemination and implementation strategies to increase the use of clinical interventions proven to benefit patients. This research proposal has the following three aims: 1) Pilot test and refine a decision aid (named SynDA) using input from patients and providers, 2) Evaluate the effects of using this decision aid in a randomized controlled trial, and 3) Conduct a dissemination and implementation project to identify quality gaps in emergency care and determine their casual factors through qualitative interviews. The results of this research have the potential to positively impact the 1 million patients who present to ED with syncope every year in the United States. The proposed activities will provide the principal investigator with knowledge and skills in the areas of clinical trials, qualitative methods, and dissemination and implementation science in order to develop, evaluate, and implement interventions to improve cardiovascular outcomes for ED syncope patients.

描述（由申请人提供）：本职业发展计划和拟议研究的目标是将主要研究者培养为独立的临床研究者，以改善晕厥患者的紧急护理。晕厥或短暂性意识丧失是晕厥患者的常见原因。它可能是由严重的心脏病引起的，但通常是良性病因的结果，尽管该领域已有数十年的研究，但这些患者住院后的临床治疗仍然存在巨大差异。非诊断性 ED 评估尚未被证明对患者有益，并且在某些情况下可能有害，这种决定通常是在没有听取患者的意愿或讨论合理替代方案的情况下做出的。当存在不止一种医学上合理的管理选择时，例如门诊患者与住院患者，患者和医生共同做出医疗保健决策，考虑到最佳可用证据以及患者的价值观和偏好。 -低风险晕厥患者的患者管理决策。辅助工具是旨在提高患者对治疗方案和可能结果的了解的另一种方法，是应用传播和实施策略来增加临床干预措施的使用，该研究提案有以下三个目标。：1) 使用患者和提供者的意见试点测试和完善决策辅助工具（名为 SynDA），2) 评估在随机对照试验中使用该决策辅助工具的效果，以及 3) 开展传播和实施项目，以确定质量差距在紧急护理和通过定性访谈确定他们的偶然因素。这项研究的结果有可能对美国每年 100 万因晕厥就诊的患者产生积极影响。拟议的活动将为主要研究者提供相关知识和技能。临床试验、定性方法以及传播和实施科学领域，以开发、评估和实施干预措施，以改善 ED 晕厥患者的心血管结局。