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

基本信息

批准号：
10079024
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
项目类别：
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/10079024
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 Theoretical Domains framework Thinness Time Training Training Activity Translating Universities Warfarin Work acceptability and feasibility base care coordination care providers care systems career career development clinical efficacy clinical practice evidence base experience heart rhythm implementation design implementation efforts implementation intervention implementation science implementation strategy implementation study improved innovation meetings model development prevent skills success theories

项目摘要

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：Geoffrey Barnes，医学博士、理学硕士是一位心脏病专家和初级临床研究员，专注于使用重组卫生系统以改善抗凝相关护理。巴恩斯博士的长期职业目标是。结合卫生系统工程原理（例如精益和六西格码工作流程模型开发和优化）并通过科学方法实施，以提高安全性和协调性心血管护理，特别是针对患有房颤的抗凝患者。拟议的 K01 指导。职业发展奖包括为期 5 年的培训和研究活动计划，该计划将为博士提供帮助。巴恩斯拥有成为一名成功的独立调查员所需的必要技能和经验。研究背景：每年有超过 500,000 名患者长期服用华法林（一种口服药物）抗凝剂）以预防与心房颤动相关的中风，需要暂时中断其治疗通常，这些房颤患者会接受较短的抗凝治疗。在手术期间使用“桥接”抗凝剂（例如肝素）有助于预防中风。强有力的证据表明，这些短效桥接抗凝剂不会导致任何中风预防有益，但确实会导致危及生命的出血。抗凝诊所配备了专家护士。和药剂师确保长期华法林抗凝治疗的安全有效。由于大多数医疗中心缺乏协调和沟通，抗凝诊所往往不参与有关抗凝药物的围手术期管理决策。需要制定一项战略，通过重新组织手术流程来确保安全、循证的围手术期抗凝治疗手术团队和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）该提案的短期目标是获得卫生系统工程所需的技能，实施科学和组织变革领导力，以制定和实施围程序抗凝系统重组，强调加强各部门之间的协调和沟通专业的。具体目标： 1) 在六个不同的领域内开发重新组织的围手术期抗凝护理模型使用卫生系统工程方法的医疗保健中心； 2) 制定重新实施战略；心房颤动患者围手术期抗凝管理的组织模型医疗保健中心组；以及 3) 进行一项实施重组围产期的单中心试点研究程序性抗凝治疗模式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研究与主要利益相关者进行访谈，以开发并优化基于证据的工作流程模型然后，他将使用利益相关者半结构化访谈来制定程序性抗凝管理。重新组织术前抗凝管理的实施策略最后，他将执行。一项单中心试点研究，实施重组的抗凝策略以评估可行性，该研究将为未来的多中心实施研究提供信息。职业发展计划：巴恩斯博士将发展卫生系统工程方面的专业知识方法，包括精益和六西格码工作流程模型开发和优化，以及巴恩斯博士职业生涯中多组件（或复杂）干预措施的实施方法方面的专业知识。发展目标将通过跨学科团队的密切指导得到支持；专家顾问小组；高级教学课程；参加专业会议和研讨会；参加定期研讨会；指导稿件准备和资助提案制定；以及实施他的研究活动将直接有助于巴恩斯博士的预防目标。通过改善提供者的协调、沟通和准备来应对抗凝药物不良事件他随后成功提交了 R01 申请。环境：巴恩斯博士的独特资源包括一支敬业且卓有成效的导师团队，他之前曾与谁合作过；一个强大的临床实验室和研究人员位于六处；抗凝诊所和医疗中心（MAQI2）以及出色的研究基础设施；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员成长为独立调查员。

项目成果

期刊论文数量（21）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Stroke and thromboembolism prevention in atrial fibrillation.

DOI：
10.1136/heartjnl-2019-314898
发表时间：
2020-01
期刊：
Heart (British Cardiac Society)
影响因子：
0
作者：
Jame S;Barnes G
通讯作者：
Barnes G

What you don't know can kill you.

DOI：
10.1002/rth2.12056
发表时间：
2018-01
期刊：
Research and practice in thrombosis and haemostasis
影响因子：
4.6
作者：
Barnes GD
通讯作者：
Barnes GD

Eligibility for Posthospitalization Venous Thromboembolism Prophylaxis in Hospitalized Patients With COVID-19: A Retrospective Cohort Study.

DOI：
10.1161/jaha.122.025914
发表时间：
2022-10-04
期刊：
JOURNAL OF THE AMERICAN HEART ASSOCIATION
影响因子：
5.4
作者：
Vaughn, Valerie M.;Ratz, David;McLaughlin, Elizabeth S.;Horowitz, Jennifer K.;Flanders, Scott A.;Middleton, Elizabeth A.;Grant, Paul J.;Kaatz, Scott;Barnes, Geoffrey D.
通讯作者：
Barnes, Geoffrey D.

Current Trends in Anticoagulation Bridging for Patients With Chronic Atrial Fibrillation on Warfarin Undergoing Endoscopy.

接受内窥镜检查的慢性心房颤动患者接受华法林抗凝桥接的当前趋势。

DOI：
10.1016/j.amjcard.2018.02.043
发表时间：
2018
期刊：
The American journal of cardiology
影响因子：
0
作者：
Slivnick,JeremyA;Yeow,RaymondY;McMahon,Colin;Paje,DavidG;Kurlander,JacobE;Barnes,GeoffD
通讯作者：
Barnes,GeoffD

Implementation Science Opportunities in Cardiovascular Medicine.