INTEGRATING PALLIATIVE CARE WITH DISEASE MANAGEMENT TO IMPROVE OUTCOMES AMONG PATIENTS WITH ADVANCED HEART FAILURE: INTERVENTIONAL RESEARCH CAREER DEVELOPMENT

将姑息治疗与疾病管理相结合，改善晚期心力衰竭患者的预后：介入研究职业发展

• 批准号: 10331448
• 负责人: Dionysios Kavalieratos
• 金额: $ 4.05万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10331448
• 关键词: INTEGRATING; PALLIATIVE; CARE; DISEASE; MANAGEMENT

PROJECT SUMMARY/ABSTRACT Candidate. The purpose of this K01 mentored career development award is to support Dionysios Kavaliera- tos, Ph.D. in establishing a clinical research program that will improve patient, caregiver, and systems out- comes in advanced heart failure (HF) through the delivery of palliative care. His long-term goal is to become an independent health services researcher conducting patient-centered comparative effectiveness research to im- prove quality of life for individuals affected by serious cardiopulmonary illness. Through this K01, his short- term goal is to learn how to design and evaluate scalable and widely disseminable interventions to integrate palliative care principles into standard cardiac management of advanced HF. Specifically, Dr. Kavalieratos will strengthen his research expertise by way of four interrelated career development objectives: (1) to deepen his understanding of the clinical management of patients with HF and the state-of-the-science regarding palliative care interventions in HF; (2) to develop expertise in designing, conducting, and evaluating complex behavioral interventions; (3) to learn dissemination and implementation science theory and methods; and (4) to develop practical skills in the management, leadership, and ethics involved in clinical research. Mentoring and Environment. Supporting Dr. Kavalieratos's career development experience is an inten- tionally-designed mentoring team composed of renowned clinicians and researchers who have an outstanding track record of mentoring junior investigators. His Primary Mentors are: Robert M. Arnold, MD FAAHPM (ex- pertise: palliative care) and Bruce L. Rollman, MD MPH (comparative effectiveness trials of collaborative care interventions). His Secondary Mentors are: Marie Bakitas, DNSc FAAN (nurse-led palliative care interven- tions) and Jeffrey Teuteberg, MD (advanced HF). In addition, Dr. Kavalieratos has assembled a Career Adviso- ry Committee to evaluate his progress towards career independence, comprising: Larry A. Allen, MD (cardio- vascular outcomes research), David Bekelman, MD MPH (palliative care interventions in HF), and Morris Weinberger, PhD (pragmatic clinical trials). As an Assistant Professor of Medicine within the University of Pittsburgh's Division of General Internal Medicine, Dr. Kavalieratos will have full access to the resources, facili- ties, and institutional capital of the School of Medicine, its Clinical and Translational Science Institute, and the University of Pittsburgh Medical Center. The Division has a strong record of developing successful independent investigators; more than 30 of its investigators have held or do hold individual career development awards. Research. Background: Over 6 million Americans live with the physical, psychosocial, and healthcare burdens of HF. Palliative care, when provided by a palliative care specialist, has been demonstrated to alleviate many of these burdens. Unfortunately, the specialty palliative care workforce is so severely limited that specialty palliative care is neither a feasible or scalable strategy to meet the needs of a growing HF population. As such, there is a critical need for innovative solutions to integrate palliative care into standard HF management, particularly for patients receiving care outside of major academic medical centers. This proposal focuses on “primary palliative care,” defined as basic palliative care delivered by clinicians without palliative care specialty training. Specific Aims: First, we will develop a patient-centered, nurse-led primary palliative care intervention for patients with advanced HF in outpatient cardiology clinics. With formative data generated in Dr. Kavalieratos's K12 award, we will develop a structured intervention using the Medical Research Council's Framework for De- velopment and Evaluation of RCTs for Complex Interventions. Second, we will conduct a pilot randomized con- trolled trial (RCT) of the intervention versus usual care to assess feasibility and fidelity. This intervention, based on the Chronic Care Model, will partner with an existing cardiology clinic nurse to deliver primary pallia- tive care, targeting the challenges and outcomes important to patients with HF and their caregivers. We will randomize 50 individuals with NYHA Class III/IV HF to the intervention or usual care. Third, we will refine the intervention by exploring its acceptability, barriers, facilitators, and mechanisms of action among patients, caregivers, and clinicians. Using the RE-AIM framework of intervention impact, we will conduct a rigorous mixed-methods evaluation of the intervention in preparation for a fully-powered comparative effectiveness tri- al. To ensure that this work is impactful, feasible, and sustainable, we have assembled an advisory board of patients, caregivers, clinicians, and administrators to provide input on all phases of this project, from interven- tion development through interpretation of results. The proposed research will provide Dr. Kavalieratos with the preliminary data, training, and experience to develop and lead a fully-powered R01-level pragmatic RCT to compare the effectiveness of primary palliative care versus usual HF care in patients with advanced HF be- ing cared for in community cardiology clinics. In turn, this award will contribute to Dr. Kavalieratos's devel- opment as a leader within the cardiopulmonary outcomes research community as he will develop, test, then deploy clinically-relevant, patient-centered strategies to promote the provision of palliative care, thereby im- proving patient, caregiver, and systems outcomes.

项目摘要/摘要 候选人。 TOS，博士 通过经过姑息治疗的经过委托。 独立卫生服务研究人员进行以患者为中心的编译有效性研究以实现 通过这种K01，证明了患有严重心肺疾病的人的生活质量。 术语目标是学习如何设计和评估可扩展和广泛的传播干预措施以整合 姑息治疗原则是高级HF的标准心脏管理。 通过四个相互关联的职业发展目标来增强他的研究专业知识：（1）加深他 了解HF患者的临床管理以及有关姑息治疗的状态科学 HF（2）的护理干预措施； 干预措施（3）学习传播和实施理论和（4） 临床研究中涉及的管理，领导和道德方面的实践技能。 指导和环境。 由著名人物和研究人员组成的典型设计的指导团队 指导初级调查员的记录是：罗伯特·阿诺德（Robert M. Arnold） 有关：姑息治疗）和MD MPH的Bruce L. Rollman（协作护理护理的比较有效性试验 干预措施）。 Tions）和医学博士Jeffrey Teuteberg（高级HF）。 RY委员会评估他在职业独立性方面的进步，作品：Larry A。 血管结果研究），David Bekelman，MD MPH（HF的姑息治疗干预措施）和Morris Weinberger，博士学位（务实的临床试验）。 匹兹堡一般内科医学司卡瓦利埃拉托斯博士将完全访问资源 纽带和医学院的现实首都，其临床和翻译科目和你 匹兹堡大学医学中心有很大的记录 调查人员;有30多个调查人员持有或持有个人职业发展奖。 研究。 背景：超过600万的美国人生活在HF的身体，社会心理和医疗保健负担。 姑息治疗虽然是姑息治疗专家，但已被证明可以减轻其中的许多 不幸的是，专业的姑息治疗工作者非常有限 护理既不是满足越来越多的HF人口的需求的人。 对创新解决方案的批判性需求将姑息治疗整合到标准的HF管理中，特别是对于 在主要学术医疗中心之外接受护理的患者。 护理，“定义为临床医生在没有姑息治疗专业培训的情况下提供的基本姑息治疗。 具体目的：首先，我们将开发以患者为中心的，由护士主导的主要姑息治疗干预措施 患者在门诊心脏病学诊所的患者。 K12奖，我们将使用医学研究委员会的DE框架进行结构化干预 - RCT的速度和评估进行复杂干预。 国际与常规护理评估和富裕的巨魔试验（RCT）。 基于慢性护理模型，将与现有心脏病学诊所护士合作，以提供主要 对HF患者及其护理人员的挑战和成果的目标。 将50个NYHA III/IV级HF的人随机进行干预或通常的护理。 通过探索患者之间的可接受性，障碍，促进因子和作用机制来进行干预， 护理人员和临床医生。 对国际的混合方法评估，以准备全力以赴的比较有效性三 为了确保工作有影响力，可行和可持续 患者，看护人，临床医生和管理人员提供该项目所有阶段的意见，从中间 通过解释结果的开发。 初步数据，培训和经验，以开发和领导fuly驱动的R01级务实的RCT 比较初级姑息治疗与常规HF护理对晚期HF患者的有效性 在社区心脏病学诊所的照顾下。 Opment如我将开发的那样，如我将开发的研究社区 部署与临床相关的，以患者为中心的策略来促进姑息治疗的提供，从而 证明患者，护理人员和系统成果。

项目成果

Coprescribing of opioids and high-risk medications in the USA: a cross-sectional study with data from national ambulatory and emergency department settings.

• DOI: 10.1136/bmjopen-2021-057588
• 发表时间: 2022-06-16
• 期刊: BMJ OPEN
• 影响因子: 2.9
• 作者: Suvada, Kara;Zimmer, Anna;Soodalter, Jesse;Malik, Jimi S.;Kavalieratos, Dio;Ali, Mohammed K.
• 通讯作者: Ali, Mohammed K.

Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home-Based Palliative Care.

• DOI: 10.1161/jaha.122.026319
• 发表时间: 2022-10-04
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Campos, Erin;Isenberg, Sarina R.;Lovblom, Leif Erik;Mak, Susanna;Steinberg, Leah;Bush, Shirley H.;Goldman, Russell;Graham, Cassandra;Kavalieratos, Dio;Stukel, Therese;Tanuseputro, Peter;Quinn, Kieran L.
• 通讯作者: Quinn, Kieran L.

The National Postdoctoral Palliative Care Research Training Collaborative: History, Activities, Challenges, and Future Goals.

国家博士后姑息治疗研究培训合作组织：历史、活动、挑战和未来目标。

• DOI: 10.1089/jpm.2020.0411
• 发表时间: 2021
• 期刊: Journal of palliative medicine
• 影响因子: 2.8
• 作者: Schenker,Yael;Ellington,Lee;Bell,Lindsay;Kross,ErinK;Rosenberg,AbbyR;Kutner,JeanS;Bickel,KathleenE;Ritchie,Christine;Kavalieratos,Dio;Bekelman,DavidB;Mooney,KathleenB;Fischer,StacyM
• 通讯作者: Fischer,StacyM

Models of Palliative Care Delivery for Individuals with Cystic Fibrosis: Cystic Fibrosis Foundation Evidence-Informed Consensus Guidelines.

• DOI: 10.1089/jpm.2020.0311
• 发表时间: 2021-01
• 期刊: Journal of palliative medicine
• 影响因子: 2.8
• 作者: Kavalieratos D;Georgiopoulos AM;Dhingra L;Basile MJ;Rabinowitz E;Hempstead SE;Faro A;Dellon EP
• 通讯作者: Dellon EP

Use of Theoretical Frameworks in the Development and Testing of Palliative Care Interventions.

• DOI: 10.1016/j.jpainsymman.2021.10.011
• 发表时间: 2022-03
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Ingle MP;Check D;Slack DH;Cross SH;Ernecoff NC;Matlock DD;Kavalieratos D
• 通讯作者: Kavalieratos D