Advancing Cardiothoracic Surgical Trials in Rural Health Populations

推进农村健康人群的心胸外科试验

• 批准号: 10774564
• 负责人: Alexander Iribarne
• 金额: $ 55.67万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-22 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10774564
• 关键词: Achievement; Age; Anesthesiology; Area; Atlases; Cardiac Surgery procedures; Cardiology; Cardiovascular Diseases; Cardiovascular system; Catchment Area; Clinical; Clinical Investigator; Clinical Research; Clinical Trials; Clinical Trials Network; Clinical Trials Unit; Collaborations; Conduct Clinical Trials; Data; Data Coordinating Center; Dedications; Education; Elderly; Enrollment; Ensure; Face; Faculty; Funding; Future; Goals; Health Policy; Home; Hospitals; Incidence; Individual; International; Knowledge; Learning; Life Expectancy; Link; Maine; Medical center; Medicare; Medicare claim; Mentored Clinical Scientist Development Program; Mentors; Mentorship; Mission; Network Infrastructure; Neurology; New England; Operative Surgical Procedures; Patient Recruitments; Patients; Population; Population Research; Public Health; Recording of previous events; Registries; Research; Research Infrastructure; Research Personnel; Role; Rural; Rural Community; Rural Health; Rural Population; Scholars Program; Scientist; Teleconferences; Training; Translational Research; Underrepresented Populations; Visit; Work; biomedical referral center; burden of illness; career; career development; clinical practice; clinical trial recruitment; comorbidity; effectiveness/implementation trial; evidence base; experience; geographic difference; implementation evaluation; implementation research; implementation science; improved; medical specialties; medically underserved; member; metropolitan; next generation; patient population; population health; process evaluation; programs; prospective; recruit; repository; research and development; rural patients; skills; socioeconomics; success; surgery outcome; surgical research; trial design

PROJECT SUMMARY The Cardiothoracic Surgical Trials Network (CTSN) has made significant contributions in advancing the evidence base for cardiothoracic surgery. As the population ages and the incidence of cardiovascular disease remains high, there is an important public health need to expand the capacity of the CTSN. Northern New England (NNE) is home to the most rural and elderly population in the US. Individuals living in NNE are medically underserved and face significant socioeconomic challenges. These conditions occur in the context of higher rates of comorbid conditions, leading to a high cardiovascular disease burden and lower life expectancy. Importantly, rural patients are underrepresented in cardiovascular clinical trials. As hospitals located in NNE, Dartmouth-Hitchcock Medical Center (DHMC) and Maine Medical Center (MMC) share a common goal of improving the health of rural communities. Specific aims are: (1) to expand the capacity of the CTSN in rural populations with high cardiovascular disease burden and develop strategies for implementing trial findings in such patients; (2) to support the development and clinical research capacity at MMC; and (3) to train the next generation of implementation science researchers through the Clinical and Implementation Research Skills Program (CIRSP). Several unique features of this collaboration will allow achievement of these aims. First, DHMC and MMC are the major referral centers for cardiac surgery in NNE, ensuring an ideal setting for recruiting patients with a high cardiovascular disease burden. Second, DHMC is an international leader in the use of regional and national registries to facilitate population-based research. DHMC is the data coordinating center for Northern New England Cardiovascular Disease Study Group (NNECDSG) which collects data on 90% of cardiac surgery in NNE. DHMC also maintains the largest non- federal repository of Medicare data in the US through the Dartmouth Atlas. Third, Dr. Iribarne has 11 years of experience with the CTSN and brings significant knowledge of lessons learned on optimal recruitment strategies for enrolling cardiac surgery patients. Fourth, DHMC and MMC have worked collaboratively in quality improvement since 1987 through the NNECDSG; the Linked Clinical Research Center (LCRC) program is a natural extension of this collaboration. Fifth, a group of nationally recognized experts in implementation science has been assembled to educate CIRSP Scholars in late-stage implementation research. The expected results are that: (1) the capacity of the CTSN will expand into rural populations with high cardiovascular disease burden; (2) implementation science will be integrated in future CTSN research; (3) MMC will be a leading enroller in CTSN trials; and (4) early career investigators will be trained in and perform late-stage implementation research using the CTSN infrastructure. These results will support the mission of the LCRC program in expanding the capacity of cardiothoracic surgery research in areas of need.

项目摘要 心胸外科手术试验网络（CTSN）在推动这一方面做出了重大贡献 心胸外科手术的证据基础。随着人口的年龄和心血管疾病的发病率 保持很高，公众健康需要扩大CTSN的能力。北部新 英格兰（NNE）是美国最农村和老年人口的所在地。居住在nne的人是 在医学上服务不足，面临重大的社会经济挑战。这些条件发生在 较高的合并症发生率，导致高心血管疾病负担和预期寿命较低。 重要的是，在心血管临床试验中，农村患者的人数不足。 作为位于NNE的医院，达特茅斯 - 希区柯克医疗中心（DHMC）和缅因州医疗中心（MMC） 共享改善农村社区健康的共同目标。具体目的是：（1）扩展 CTSN在农村人口中具有高心血管疾病负担的能力，并制定了策略 在此类患者中实施试验结果； （2）支持开发和临床研究能力 MMC; （3）通过临床和 实施研究技能计划（CIRSP）。这项合作的几个独特功能将允许 实现这些目标。首先，DHMC和MMC是NNE心脏手术的主要转诊中心 确保招募高心血管疾病负担的患者的理想环境。其次，DHMC是 使用区域和国家登记处的国际领导者来促进基于人群的研究。 DHMC是北部新英格兰心血管疾病研究小组的数据协调中心 （NNECDSG）收集有关NNE 90％心脏手术的数据。 DHMC还保持最大的非 美国通过达特茅斯地图集的联邦医疗保险数据存储库。第三，Iribarne博士有11年 具有CTSN的经验，并带来了有关最佳招聘的经验教训的重要知识 参加心脏手术患者的策略。第四，DHMC和MMC在 自1987年以来通过NNECDSG提高质量；链接的临床研究中心（LCRC）计划 是这种合作的自然扩展。第五，一群全国认可的实施专家 科学已被组成，以对CIRSP学者进行晚期实施研究的教育。 预期的结果是：（1）CTSN的能力将扩展到较高的农村人群 心血管疾病负担； （2）实施科学将集成到未来的CTSN研究中； （3） MMC将是CTSN试验的领先入学者； （4）早期职业调查人员将接受培训和执行 使用CTSN基础架构的后期实施研究。这些结果将支持 LCRC计划扩大了心胸外科研究在需要领域的能力。