Project MISSION: Developing a multicomponent, Multilevel Implementation Strategy for Syncope OptImalCare thrOugh eNgagement

项目使命：通过参与制定晕厥优化护理的多组成部分、多层次实施策略

基本信息

批准号：
9755244
负责人：
Jing Li
金额：
$ 50.94万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9755244
关键词：
Academic Medical Centers Accident and Emergency department Activities of Daily Living Adherence Adopted Adoption Adult Affect American American Heart Association Assessment tool Atrial Fibrillation Attitude Cardiac Cardiology Cardiovascular system Caring Characteristics Chronic low back pain Climate Clinical Clinical Practice Guideline Collaborations Community Hospitals Complex Dangerousness Data Diagnosis Diagnostic Distress Effectiveness Emergency Department Physician Emergency Medicine Emergency department visit Etiology Evaluation Event Functional disorder Goals Guidelines Health Hospitalization Hospitals Hybrids Impairment Interview Knowledge Mediating Medicine Mental Health Morbidity - disease rate Organizational Culture Orthostatic Hypotension Participant Patient-Focused Outcomes Patients Perception Population Prevalence Process Provider Public Health Quality of life Readiness Recommendation Recurrence Reflex action Reporting Research Rheumatoid Arthritis Risk Social Environment Societies Standardization Structure Surveys Symptoms Syncope System Testing Time Translations Unconscious State Vasovagal Work adverse outcome base clinical care clinical practice college common symptom design evidence base experience heart rhythm high risk implementation research implementation strategy implementation trial improved mortality mortality risk novel outcome forecast physical conditioning social organization tool

项目摘要

Project Abstract Syncope is a complex presenting symptom that requires thoughtful and efficient evaluation to determine the etiology of a patient's loss of consciousness. Prevalence rates of syncope have been reported as high as 41%, with recurrent syncope occurring in 13.5%. A common symptom, approximately 1% to 3% of all emergency department (ED) visits (as many ED visits as atrial fibrillation) and up to 6% of all hospital admissions are due to syncope. The prognosis among patients with syncope depends on the etiology and underlying cardiovascular condition. A cardiac etiology of syncope is associated with significantly higher rates of morbidity and mortality than other causes such as vasovagal reflex mediated or orthostatic hypotension. The Framingham study documented a doubling of the risk of death among participants with cardiac syncope compared with those with non-cardiac syncope. Notably, experiencing syncope affects patients' quality of life (QoL), and those with more frequent syncope report poorer QoL with perceptions of low overall physical and mental health and impairment in activities of daily living. The QoL among patients with recurrent syncope appears equivalent to severe rheumatoid arthritis and chronic low-back pain in an adult population. Though research in the past 25 years provides substantial understanding of the pathophysiology of particular etiologies of syncope, the diagnostic approach to such a perplexing symptom remains difficult and efficient diagnosis remains elusive. The major challenge in the evaluation of patients with syncope is that most patients are asymptomatic at the time of their presentation. Because of concerns that patients presenting with syncope are at risk for an impending catastrophic event, overuse and inappropriate use of testing and hospital admission are common. Aiming to provide guidance on optimizing the evaluation and management of syncope, a collaboration of the American College of Emergency Physicians, Society for Academic Emergency Medicine, American College of Cardiology (ACC), American Heart Association (AHA) and Heart Rhythm Society (HRS) issued a Guideline for the Evaluation and Management of Patients with Syncope in 2017. Adopting a standardized approach to syncope based on this guideline offers an effective opportunity for delivering high value care to patients suffering this distressing and potentially dangerous event. Aiming for more rapid translation from guideline to clinical practice and improved health, the proposed study will identify barriers and facilitators for implementation of an evidence-based, high value approach to diagnosis and management of patients presenting with syncope. The research team will develop a multi-level, multi-component implementation strategy for evidence-based syncope evaluation and management and plan for a subsequent hybrid effectiveness-implementation trial, guided by the Consolidated Framework for Implementation Research (CFIR).

项目摘要晕厥是一种复杂的症状，需要进行深思熟虑和有效的评估确定患者意识丧失的病因。据报道晕厥的患病率高达41%，其中13.5%发生反复晕厥。常见症状，约占 1% 至 3% 所有急诊科 (ED) 就诊次数（急诊科就诊次数与心房颤动次数相同）以及高达所有医院的 6% 因晕厥入院。晕厥患者的预后取决于病因和潜在的心血管疾病。晕厥的心脏病病因与显着较高的发生率相关发病率和死亡率高于其他原因，例如血管迷走神经反射介导的或体位性低血压。这弗雷明汉研究记录了心源性晕厥参与者的死亡风险增加了一倍与非心源性晕厥患者相比。值得注意的是，晕厥会影响患者的生活质量 (QoL)，而那些经常晕厥的人报告的 QoL 较差，认为整体身体和健康水平较低。心理健康和日常生活活动受损。反复晕厥患者的生活质量似乎相当于成年人中的严重类风湿性关节炎和慢性腰痛。尽管过去 25 年的研究为特定病因的病理生理学提供了深入的了解对于晕厥，这种令人困惑的症状的诊断方法仍然是困难和有效的诊断仍然难以捉摸。评估晕厥患者的主要挑战是大多数患者没有症状在他们演讲时。由于担心出现晕厥的患者有发生晕厥的风险即将发生的灾难性事件、过度使用和不恰当地使用检测和入院是很常见的。旨在为优化晕厥的评估和管理提供指导，美国急诊医师学会、学术急诊医学学会、美国急诊医师学会心脏病学 (ACC)、美国心脏协会 (AHA) 和心律协会 (HRS) 发布了指南 2017年晕厥患者的评估和管理。采用标准化方法基于该指南的晕厥为向患者提供高价值护理提供了有效的机会遭受这一令人痛苦且具有潜在危险的事件。旨在更快地从指南转化为临床实践和改善健康，拟议的研究将确定障碍和促进因素实施基于证据的高价值方法来诊断和管理患者表现为晕厥。研究团队将开发一个多层次、多组件的实施方案基于证据的晕厥评估和管理策略以及后续混合计划以实施研究综合框架为指导的有效性实施试验（CFIR）。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Value-based syncope evaluation and management: Perspectives of health care professionals on readiness, barriers and enablers.

基于价值的晕厥评估和管理：医疗保健专业人员对准备情况、障碍和推动因素的看法。

DOI：
发表时间：
2020
期刊：
影响因子：
0
作者：
Li, Jing;Gupta, Vedant;Smyth, Susan S;Cowley, Amy;Du, Gaixin;Sirrine, Matthew;Stearley, Seth;Chadha, Romil;Bhalla, Vikas;Williams, Mark V
通讯作者：
Williams, Mark V

Identifying Guideline-Practice Gaps to Optimize Evaluation and Management for Patients With Syncope.

确定指南与实践之间的差距，以优化晕厥患者的评估和管理。

DOI：
发表时间：
2021
期刊：
影响因子：
0
作者：
Smyth, Susan;Gupta, Vedant;Williams, Mark;Cowley, Amy;Sirrine, Matthew;Surratt, Hilary;Chadha, Romil;Stearley, Seth;Bhalla, Vikas;Li, Jing
通讯作者：
Li, Jing

Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool.

开发并展示晕厥最佳护理多级实施策略的可行性和可用性，通过参与 (MISSION) 晕厥应用程序：基于证据的临床决策支持工具。

DOI：
发表时间：
2021
期刊：
影响因子：
7.4
作者：
Amin, Shiraz;Gupta, Vedant;Du, Gaixin;McMullen, Colleen;Sirrine, Matthew;Williams, Mark V;Smyth, Susan S;Chadha, Romil;Stearley, Seth;Li, Jing
通讯作者：
Li, Jing

"Passing Out is a Serious Thing": Patient Expectations for Syncope Evaluation and Management.

“昏倒是一件严重的事情”：患者对晕厥评估和管理的期望。

DOI：
发表时间：
2021
期刊：
影响因子：
0
作者：
Clouser, Jessica Miller;Sirrine, Matthew;McMullen, Colleen A;Cowley, Amy M;Smyth, Susan S;Gupta, Vedant;Williams, Mark V;Li, Jing
通讯作者：
Li, Jing

Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework.

使用 CFIR 框架规划急诊科晕厥临床实践指南的成功实施。