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.

项目摘要/摘要 作为一名血管和介入放射科医生和卫生服务研究人员，我的长期目标是实现 通过国家护理评估和 实施务实的发明以改善结果。这项研究和培训建议将使我能够 获得建立独立性并推出以科学贡献为重点的关键技能 关于系统级质量改善静脉血栓栓塞（VTE）相关护理。 这项研究建议的目的是增加次要腔静脉过滤器（IVCF）和 改善美国的患者预后。下腔静脉过滤器通常放置在患者中 腿部血凝块（深静脉血栓形成； DVT）或肺（肺栓塞； PE），以防止 向心脏传播，可能是致命的。不幸的是，全国检索率仍然很低且延长 IVCF植入已导致相当大的发病率。多社会指南 强调有必要通过结构化后续计划来提高及时的IVCF检索率 并更好地了解哪些程序组件在现实世界中有效。接下来需要什么 是对实用策略的识别和测试，以改善现实世界中的及时IVCF检索。我们 提议通过三个免费目标来执行此操作：1）IVCF检索中设施级变化的量化 整个美国； 2）高绩效机构的定性表征以确定最佳实践 并描述了其实施的促进者和障碍； 3）设计，试点测试和迭代 改编务实的干预措施，以改善IVCF检索，并由现有文献告知 并适应AIM 2的发现。然后将在多中心混合动力学中测试实用干预措施 遵循的实施效果试验，目的是改善及时的IVCF检索和减少 美国各医院的并发症。 我的培训的目的是通过集中教育与提议的研究方法相似：a） 贝叶斯医院概况，b）定性访谈和分析，以及c）使用 实施科学框架。该培训将通过结构化的故意组合来完成 课程工作，正式的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）的指导团队和研究环境是理想情况下 适合该提议。我的主要导师P. Michael Ho MD博士是心血管的国家领导者 质量评估和务实的干预设计。我还将利用广泛的数据和 成人和儿童财团的方法论核心资源研究和分娩科学 （协议）和Data2Value（D2V）在科罗拉多大学实现这些目标的计划。