Implementation research for comprehensive cardiometabolic care in Guatemala

危地马拉综合心脏代谢护理的实施研究

• 批准号: 10686102
• 负责人: David Clifford Flood
• 金额: $ 19.05万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686102
• 关键词: Address; Adoption; Antihypertensive Agents; Award; Behavior Therapy; Belize; Cardiometabolic Disease; Cardiovascular Diseases; Caring; Central America; Central American; Cessation of life; Chronic; Chronic Disease; Clinical; Clinical Trials; Consensus; Costa Rica; Counseling; Country; Developing Countries; Diabetes Mellitus; Disease; Disease Management; Disease Outcome; Dyslipidemias; Educational workshop; El Salvador; Elements; Evaluation; Evidence based intervention; Evidence based treatment; Fellowship; Floods; Funding; Glucose; Goals; Guatemala; Guatemalan; Health; Health Personnel; Health Services; Health system; Heart; Heart failure; Honduras; Hypertension; Income; Internist; Intervention; Intervention Studies; Interview; Investments; Knowledge; Latin America; Medicine; Mentors; Mentorship; Metabolic Diseases; Methodology; Methods; Michigan; Modeling; Monitor; Morbidity - disease rate; Myocardial Ischemia; National Heart, Lung, and Blood Institute; Nicaragua; Outcome; Panama; Participant; Patients; Physicians; Pilot Projects; Positioning Attribute; Prevention; Primary Care; Primary Health Care; Protocols documentation; Public Health; Randomized; Recommendation; Research; Research Methodology; Research Personnel; Resources; Risk; Saints; Sampling; Scientist; Strategic vision; Stroke; Structure; System; Training; Translating; Universities; World Health Organization; Zea; acceptability and feasibility; cardiometabolism; care delivery; career; career development; cost effective; design; effective intervention; effectiveness evaluation; effectiveness outcome; evidence base; experience; health training; healthy lifestyle; human centered design; hybrid type 2 trial; hypertension treatment; implementation barriers; implementation intervention; implementation outcomes; implementation research; implementation study; improved; improved outcome; low and middle-income countries; member; mortality; multi-component intervention; multidisciplinary; nutrition; pharmacologic; primary outcome; public health relevance; research clinical testing; research study; skills; therapy design; training opportunity

PROJECT SUMMARY Candidate: David Flood, MD, MSc, is a general internist and fellowship-trained health services researcher at the University of Michigan and the Institute of Nutrition of Central America and Panama (INCAP) in Guatemala. Dr. Flood’s long-term career goal is to become an independent physician-scientist who uses expertise in implementation research to improve the adoption of evidence-based interventions for the prevention, treatment, and control of cardiometabolic diseases (e.g., hypertension, diabetes, and dyslipidemia) in resource-limited health systems in the U.S. and globally. Background: Pharmacologic and behavioral interventions are effective in improving cardiometabolic disease outcomes. However, limited implementation of these interventions in low- and middle-income countries (LMICs) leads to substantial excess morbidity and mortality. The Hearts Technical Package for Cardiovascular Disease Management in Primary Health Care is the model recommended by the World Health Organization to address this implementation gap (“HEARTS”: Healthy lifestyle counseling, Evidence-based protocols, Access to medicines, Risk-based care, Task sharing, and Systems monitoring). Despite compelling supporting evidence, HEARTS has not been implemented in most LMICs. Training Plan: To achieve research independence, Dr. Flood requires additional training in (1) applying implementation research methods, (2) human-centered design of interventions, and (3) mixed methods design and evaluation of clinical trials. Dr. Flood will be mentored by an outstanding, multinational team including Co-Primary Mentors Dr. Michele Heisler (University of Michigan) and Dr. Manuel Ramírez-Zea (INCAP) who have extensive mentoring experience and expertise implementing chronic disease interventions. His Co-Mentor will be Dr. Gretchen Piatt (implementation research). Dr. Flood’s advisors will include Drs. Sanjay Saint (consensus design methods), Mark Huffman (translating research between global and U.S. settings), Vilma Irazola (implementation research in Latin America), and Timothy Guetterman (mixed methods). Research Plan: With guidance from his mentors and advisors, Dr. Flood will carry out a detailed study of HEARTS implementation in a single country, Guatemala, which can serve as a generalizable implementation template for use in other LMICs. The research plan will build and expand on an ongoing NHLBI-funded hypertension implementation study in Guatemala (of which Co-Primary Mentor Dr. Ramírez-Zea is Co-PI). Using a stepwise approach, Dr. Flood will (1) identify barriers and facilitators to expanding an ongoing hypertension intervention in Guatemala to also include diabetes and dyslipidemia treatment, as recommended in WHO Hearts; (2) co-design a delivery model of integrated treatment of cardiometabolic diseases using human-centered design, and (3) evaluating the feasibility and acceptability of the delivery model using a mixed-methods evaluation of a cluster randomized pilot study. Findings from this award will position Dr. Flood to submit an R01 application to evaluate effectiveness and implementation outcomes in a type 2 hybrid trial.

项目摘要 候选人：医学博士大卫·弗林（David Flood 密歇根大学和危地马拉的中美洲和巴拿马营养研究所（INCAP）。 Flood博士的长期职业目标是成为一名独立医师科学家，他使用专业知识 提高采用基于证据的干预措施以进行预防的公关部门， 心脏代谢疾病的治疗和控制（例如，高血压，糖尿病和血脂异常） 美国和全球的资源有限卫生系统：药理学和行为 干预措施有效改善心脏代谢疾病的结果。 具有大量过剩的发病率和大量过量发病率的质量大量过剩发病率 死亡率。 世界卫生组织推荐的模型以解决此实施差距（“ Hearts”： 健康的生活方式咨询，基于证据的方案，获得医学，基于风险的护理，任务共享， 和系统监视）。 大多数LMIC：为了实现研究独立性，洪水博士需要（1） 应用实施研究方法，（2）以人为中心的国际设计，以及（3）混合 方法设计和评估临床试验。 团队包含共同的指导者米歇尔·海斯勒（Michele Heisler）博士 （Incap）拥有丰富的指导经验和实施慢性疾病干预的专业知识。 他的院长将是Gretchen Piatt博士（实施研究）。 Sanjay Saint（共识设计方法），Mark Huffman（全球和美国之间的研究翻译 设置），Vilma Irazola（拉丁美洲的实施研究）和Timothy Guetterman（混合方法）。 研究计划：在他的导师和顾问的指导下，Flood博士将对 心脏在一个国家的危地马拉中的含义，可以用作一般的成员 在其他LMIC中，我们的模板将在持续的NHLBI资助上扩展 危地马拉的高血压实施研究（其中共同主要导师博士 洪水博士使用逐步的方法（1）确定障碍和促进者以扩大Angoing 如建议的 在谁的心中； 以人为中心的设计，以及（3）使用 聚类随机试验研究的混合方法评估。 要提交R01应用程序以评估评估评估评估评估评估评估评估评估评估评估评估评估评估评估评估评估评估和在2型混合试验中的结果。

项目成果

The triglyceride glucose index and cardiovascular disease outcomes.

• DOI: 10.1016/s2666-7568(22)00269-0
• 发表时间: 2023-01
• 期刊: LANCET HEALTHY LONGEVITY
• 影响因子: 13.1
• 作者: Flood, David;Brant, Luisa Campos Caldeira;Sussman, Jeremy B
• 通讯作者: Sussman, Jeremy B

Prevalence of diabetes among Indigenous women in Guatemala: A retrospective chart review study of 13 643 patients between 2015-2022.

危地马拉土著妇女糖尿病患病率：2015 年至 2022 年期间对 13 643 名患者进行的回顾性图表审查研究。

• DOI: 10.1101/2024.01.08.24300932
• 发表时间: 2024
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Alajajian,Stephen;Bartolimin,Jenny;Martin,YolandaJuarez;Scott,Caitlin;Rohloff,Peter;Flood,David
• 通讯作者: Flood,David

Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories.

• DOI: 10.1371/journal.pgph.0002768
• 发表时间: 2024
• 期刊: PLOS global public health