Implanted but not forgotten: identifying and testing pragmatic strategies to improve inferior vena cava filter retrieval

植入但不被遗忘：识别和测试改善下腔静脉滤器回收的实用策略

• 批准号: 10650821
• 负责人: Premal S Trivedi
• 金额: $ 18.73万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-01
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650821
• 关键词: Address; Adoption; Adult; Anticoagulants; Blood Vessels; Blood coagulation; Cardiovascular system; Caring; Child; Clinic; Clinical; Coagulation Process; Colorado; Communities; Computerized Medical Record; Data; Dedications; Deep Vein Thrombosis; Devices; Doctor of Philosophy; Education; Educational workshop; Ensure; Environment; Excision; Fracture; Goals; Guidelines; Health; Health Services; Health system; Heart; Hospitals; Implant; Inferior vena cava structure; Informatics; Injury; Institution; Intervention; Interview; Lead; Leadership; Leg; Life; Literature; Lung; Measures; Medicare; Mentors; Mentorship; Methodology; Morbidity - disease rate; Nurses; Organ; Outcome; Outcomes Research; Patient Care; Patient-Focused Outcomes; Patients; Patterns of Care; Penetration; Physicians; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Process; Provider; Publishing; Pulmonary Embolism; Quality of Care; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Retrieval; Safety; Science; Scientist; Societies; Structure; System; Testing; Thrombosis; Time; Training; United States; Universities; Variant; Veins; Vena Cava Filters; Work; acceptability and feasibility; contextual factors; deep vein; design; effectiveness/implementation trial; electronic medical record tool; experience; follow-up; implantation; implementation framework; implementation science; improved; improved outcome; invention; migration; multidisciplinary; pilot test; pragmatic intervention; prevent; programs; radiologist; skills; therapy design; venous thromboembolism

PROJECT SUMMARY/ABSTRACT As a vascular and interventional radiologist and a health services researcher, my long-term goal is to achieve transformative improvements in vascular procedural care through national quality of care assessments and implementing pragmatic inventions to improve outcomes. This research and training proposal will allow me to gain critical skills needed to establish independence and launch a portfolio of scientific contributions focused on systems-level quality improvement in venous thromboembolism (VTE) related care. The goal of this research proposal is to increase timely retrieval of inferior vena cava filters (IVCF) and improve patient outcomes in the United States. Inferior vena cava filters are very commonly placed in patients with blood clots in the leg (deep venous thrombosis; DVT) or lungs (pulmonary embolism; PE), to prevent propagation to the heart, which can be fatal. Unfortunately, national retrieval rates remain low and prolonged IVCF implantation has resulted in considerable, avoidable morbidity. Multi-society guidelines recently emphasized the need to improve timely IVCF retrieval rates through institution of structured follow up programs and to better understand which program components are effective in real world settings. What is needed next is identification and testing of pragmatic strategies to improve timely IVCF retrieval in real-world settings. We propose to do this via three complimentary aims: 1) quantification of facility-level variation in IVCF retrieval across the United States; 2) qualitative characterization of high-performing institutions to identify best practices and characterize facilitators and barriers to their implementation; 3) design, pilot testing and iterative adaptation of a pragmatic intervention package to improve IVCF retrieval, informed by the existing literature and adapted with findings from aim 2. The pragmatic intervention will then be tested in multi-center hybrid implementation-effectiveness trials to follow, with the goal of improving timely IVCF retrieval and reducing complications across hospitals in the United States. My training aims closely parallel the proposed research methodology through focused education in: a) Bayesian hospital profiling, b) qualitative interviewing and analysis, and c) intervention design using an implementation science framework. This training will be accomplished through an intentional mix of structured coursework, formal workshop experience and one-on-one education with topical research experts. My mentorship team and research environment at the University of Colorado Denver (UCD) are ideally suited to this proposal. My primary mentor, P. Michael Ho MD PhD, is a national leader in cardiovascular quality assessment and pragmatic intervention design. I will additionally leverage the extensive data and methodologic core resources of Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS) and Data2Value (D2V) initiatives at the University of Colorado to accomplish these aims.

项目概要/摘要 作为一名血管和介入放射科医生以及卫生服务研究员，我的长期目标是实现 通过国家护理质量评估和血管手术护理的变革性改进 实施务实的发明以改善成果。这项研究和培训计划将使我能够 获得建立独立性和推出一系列科学贡献所需的关键技能 静脉血栓栓塞 (VTE) 相关护理的系统级质量改进。 本研究提案的目标是提高下腔静脉滤器 (IVCF) 的及时回收率和 改善美国患者的治疗效果。下腔静脉过滤器非常常放置在患者体内 腿部（深静脉血栓形成；DVT）或肺部（肺栓塞；PE）出现血栓，以预防 传播到心脏，这可能是致命的。不幸的是，全国检索率仍然很低且持续时间较长 IVCF 植入导致了相当大的、可以避免的发病率。最近多社会指南 强调需要通过制定结构化的后续计划来提高及时 IVCF 检索率 并更好地了解哪些程序组件在现实环境中有效。接下来需要什么 是识别和测试实用策略，以改善现实环境中 IVCF 的及时检索。我们 建议通过三个补充目标来做到这一点：1）IVCF 检索中设施水平变化的量化 美国各地； 2) 对高绩效机构进行定性描述，以确定最佳实践 并描述其实施的促进因素和障碍； 3）设计、中试和迭代 根据现有文献，调整实用的干预方案以改善 IVCF 检索 并根据目标 2 的发现进行调整。然后将在多中心混合中测试务实的干预措施 随后进行实施效果试验，目标是改进 IVCF 的及时检索并减少 美国各医院的并发症。 我的培训目标是通过以下方面的重点教育与拟议的研究方法密切相关：a) 贝叶斯医院概况分析，b) 定性访谈和分析，以及 c) 使用 实施科学框架。该培训将通过有意识的结构化组合来完成 课程作业、正式研讨会经验以及与主题研究专家的一对一教育。 我在科罗拉多大学丹佛分校 (UCD) 的导师团队和研究环境非常理想 适合本提案。我的主要导师 P. Michael Ho MD 博士，是心血管领域的国家领导者 质量评估和务实的干预设计。我还将利用广泛的数据和 成人和儿童成果研究和交付科学联盟的方法学核心资源 科罗拉多大学的 (ACCORDS) 和 Data2Value (D2V) 计划旨在实现这些目标。