Developing an Implementation Strategy to Improve Peri-procedural Anticoagulation Management for Patients with Atrial Fibrillation

制定实施策略以改善心房颤动患者的围手术期抗凝管理

• 批准号: 9222184
• 负责人: Geoffrey Douglas Barnes
• 金额: $ 16.85万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9222184
• 关键词: Abnormal coordination; Adherence; Adverse event; Anticoagulants; Anticoagulation; Applications Grants; Atrial Fibrillation; Blood coagulation; Cardiology; Cardiovascular system; Caring; Chronic; Clinic; Clinical; Clinical Investigator; Communication; Complex; Decision Making; Development; Development Plans; Educational workshop; Engineering; Ensure; Equilibrium; Evaluation; Event; Exercise; Expert Opinion; Future; Goals; Health Personnel; Health Policy; Health system; Healthcare; Healthcare Systems; Hemorrhage; Heparin; Individual; Institutes; Interruption; Intervention; Interview; K-Series Research Career Programs; Laboratories; Laboratory Personnel; Lead; Leadership; Life; Manuscripts; Maps; Mentors; Mentorship; Methods; Michigan; Modeling; Nurses; Operative Surgical Procedures; Oral; Organizational Change; Patient Care; Patients; Pharmaceutical Preparations; Pharmacists; Pilot Projects; Preparation; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Regimen; Research; Research Activity; Research Infrastructure; Research Personnel; Resources; Risk; Safety; Site; Specialist; Stroke; Stroke prevention; Structure; Surgeon; System; Thinness; Time; Training; Training Activity; Translating; Universities; Warfarin; Work; base; care systems; career; career development; clinical efficacy; clinical practice; design; evidence base; experience; heart rhythm; implementation science; improved; innovation; meetings; model development; prevent; skills; success; theories

Abstract: CANDIDATE: Geoffrey Barnes, MD, MSc is a cardiologist and junior clinical investigator focused on using health system re-organization to improve anticoagulation-related care. Dr. Barnes' long-term career objective is to combine health systems engineering principles (e.g. Lean and Six Sigma work flow model development and optimization) along with implementation science approaches to improve the safety and coordination of cardiovascular care, especially for anticoagulated patients with atrial fibrillation. The proposed K01 mentored career development award includes a 5-year plan for training and research activities that will provide Dr. Barnes with the necessary skills and experience needed to become a successful independent investigator. RESEARCH CONTEXT: Over 500,000 patients each year who are chronically taking warfarin (an oral anticoagulant) to prevent strokes related to atrial fibrillation require a temporary interruption of their anticoagulant regimen for a surgery or procedure. Commonly, these atrial fibrillation patients receive shorter- acting “bridging” anticoagulants (e.g. heparin) around the time of surgery to help prevent strokes. However, robust evidence indicates that these shorter-acting bridging anticoagulants do not provide any stroke prevention benefit, but do cause life-threatening bleeding. Anticoagulation clinics are staffed by expert nurses and pharmacists to ensure safe and effective management of chronic warfarin anticoagulation. However, due to a lack of coordination and communication within most healthcare centers, anticoagulation clinics are often not involved in the peri-procedural management decisions about anticoagulant medications. There is great need for a strategy to ensure safe, evidence-based peri-procedural anticoagulation care by re-organizing the coordination between the surgical team and other providers (e.g. cardiology, primary care, and anticoagulation clinic). The short-term goal of this proposal is to acquire the requisite skills in health systems engineering, implementation science and organizational change leadership to develop and implement a peri-procedural anticoagulation system re-organization that emphasized improved coordination and communication between practitioners. SPECIFIC AIMS: 1) Develop a re-organized model of peri-procedural anticoagulation care within six diverse healthcare centers using health systems engineering methods; 2) Develop an implementation strategy for a re- organized model of peri-procedural anticoagulation management of atrial fibrillation patients within a diverse group of healthcare centers; and 3) Perform a single-center pilot study of implementing a re-organized peri- procedural anticoagulation delivery model emphasizing improved intra-organizational provider coordination and communication. RESEARCH PLAN: To accomplish these aims, Dr. Barnes will perform direct observations and semi-structured interviews with key stakeholders to develop and then optimize a work flow model for evidence-based peri- procedural anticoagulation management. He will then use stakeholder semi-structured interviews to develop an implementation strategy for re-organizing per-procedural anticoagulation management. Finally, he will perform a single center pilot study where the re-organized anticoagulation strategy is implemented to assess feasibility, acceptability and efficacy. This study will inform a future multi-center implementation study. CAREER DEVELOPMENT PLAN: Dr. Barnes will develop expertise in health systems engineering approaches, including Lean and Six Sigma work flow model development and optimization, along with expertise in implementation methods for multi-component (or complex) interventions. Dr. Barnes' career development goals will be supported through close mentorship from an interdisciplinary team; guidance from an expert advisory panel; advanced didactic coursework; attendance at professional meetings and workshops; participation in regular seminars; guidance in manuscript preparation and grant proposal development; and implementing his research activities. This training will directly contribute to Dr. Barnes' goal of preventing adverse anticoagulant drug events through improved provider coordination and communication and prepare him to subsequently submit a successful R01 application. ENVIRONMENT: Dr. Barnes' unique resources include a dedicated and accomplished mentorship team with whom he has previously collaborated; a robust clinical laboratory and research personnel located at six anticoagulation clinics and healthcare centers (MAQI2); and the outstanding research infrastructure at the University of Michigan and Institute for Healthcare Policy and Innovation with demonstrated success in supporting junior investigators as they develop into independent investigators.

抽象的： 候选人：医学博士Geoffrey Barnes，MSC是一名心脏病专家和初级临床研究者 卫生系统重组以改善与抗凝相关的护理。巴恩斯博士的长期职业目标是 结合卫生系统工程原理（例如精益和六个Sigma工作流程模型开发和 优化）以及实施科学方法，以提高安全和协调 心血管护理，特别是对于心房颤动的抗凝患者。拟议的K01指导 职业发展奖包括一项为期5年的培训和研究活动计划，该计划将为博士提供。 Barnes具有必要的技能和经验才能成为成功的独立调查员。 研究环境：每年长期服用华法林的患者超过500,000名 抗凝剂）以防止与房颤有关的中风，需要暂时中断其 进行手术或手术的抗凝剂方案。通常，这些心房颤动患者接受了较短的 在手术时期，作用“桥接”抗凝剂（例如肝素），以防止中风。然而， 有力的证据表明，这些短作用的桥接抗凝剂不提供任何中风 预防益处，但确实会导致威胁生命的出血。抗凝诊所由专家护士组成 和药剂师，以确保对慢性华法林抗凝治疗的安全有效管理。但是，到期 由于大多数医疗中心缺乏协调和沟通，抗凝诊所通常是 不参与有关抗凝药物的围场管理决策。那里很棒 需要一项策略，以确保安全的，基于证据的验证围场抗凝治疗，通过重新组织 外科团队与其他提供者之间的协调（例如心脏病学，初级保健和抗凝治疗 诊所）。该建议的短期目标是获得卫生系统工程中所需的技能， 实施科学和组织变革的领导才能开发和实施围场 抗凝系统重组，强调改善协调和沟通 从业者。 具体目的：1）在六个潜水员内开发一个重组的围场抗凝护理模型 使用卫生系统工程方法的医疗保健中心； 2）制定重新实施策略 潜水员中房颤患者的心房纤颤术的有组织模型 医疗中心集团； 3）执行单个中心试点研究，以实施重组的周期 程序性抗凝交付模型强调改善组织内提供者的协调和 沟通。 研究计划：为了实现这些目标，巴恩斯博士将进行直接观察和半结构化的观察 与主要利益相关者的访谈以开发并优化一个工作流程模型，以用于基于证据 程序性抗凝管理。然后，他将使用利益相关者半结构化访谈来开发 实施策略，用于重组每个术的抗凝管理。最后，他会表演 一项单一中心试点研究，该研究实施了重组抗凝策略以评估可行性， 可接受性和效率。这项研究将为未来的多中心实施研究提供信息。 职业发展计划：Barnes博士将在卫生系统工程中发展专业知识 方法，包括精益和六个Sigma工作流程模型的开发和优化，以及 多组件（或复杂）干预措施实施方法方面的专业知识。巴恩斯博士的职业 发展目标将通过跨学科团队的紧密思想来支持；来自 专家咨询小组；高级教学课程；参加专业会议和研讨会； 参加常规半手；手稿准备和赠款提案制定的指导；和 实施他的研究活动。这项培训将直接有助于巴恩斯博士的防止 通过改进提供者的协调和沟通并准备不良抗凝药物事件 他随后提交成功的R01申请。 环境：Barnes博士的独特资源包括一个专门和成就的Mentalship团队 他以前合作的人；一个六个的强大临床实验室和研究人员 抗凝诊所和医疗保健中心（MAQI2）；以及杰出的研究基础设施 密歇根大学和医疗保健政策与创新研究所，在 支持初级调查人员发展成为独立研究人员时。