Guideline to Implementation: A Rapid Clinical Care Pathway to Care for Patients Affected by Chronic Constipation

实施指南：治疗慢性便秘患者的快速临床护理途径

基本信息

批准号：
10570628
负责人：
Eric Dinesh Shah
金额：
$ 19.32万
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：
2023
资助国家：
美国
起止时间：
2023-05-15 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10570628
关键词：
Academic Medical Centers Adoption Affect Automobile Driving Caring Chronic Chronic Care Clinic Clinical Colonoscopy Community Practice Constipation Consultations Data Devices Diagnostic Equipment Diagnostic Procedure Disease Effectiveness Electronic Health Record Endoscopy Fiber Funding Gastroenterologist Gastroenterology Gastrointestinal Motility Goals Grant Guidelines Health Health system Image Impairment Improve Access Intake Intervention Medical Multicenter Trials Needs Assessment Outpatients Pathway interactions Patient Care Patient Triage Patients Pelvic floor structure Pelvis Physical therapy Physiological Point of Care Technology Population Positioning Attribute Positive Reinforcements Practice Guidelines Prediction of Response to Therapy Process Production Provider Quality of life Questionnaires Recommendation Rectum Refractory Rehabilitation therapy Research Research Personnel Rotation Specialized Center Symptoms Technology Testing Training Treatment outcome Triage United States National Institutes of Health Visit Work behavioral economics career cell motility clinical care clinical decision support clinical practice cost design diagnostic technologies effective therapy evidence base health care delivery implementation science implementation trial improved laxative learned behavior medical specialties motility disorder novel patient population physical therapist pilot trial point of care point-of-care diagnostics practice setting prospective provider adoption provider behavior randomized trial rectal response routine care success support tools targeted treatment technology development tertiary care treatment as usual usability user centered design

项目摘要

PROJECT SUMMARY Technology development is a stated goal of the NIH. Myriad promising technologies have been developed, yet few cross the chasm to adoption. Few NIH-funded researchers are trained to develop and sustain transformative clinical care pathways that harness novel, evidence-based technologies to improve patient health. This training grant proposes to close this gap. Chronic constipation is one of the most frequent medical complaints and leads to 2 million gastroenterology referrals each year in the US. For symptomatic constipation refractory to laxatives, practice guidelines recommend physiological testing to identify anorectal evacuation disorders that preferentially respond to safe and effective pelvic rehabilitation therapy typically delivered by a physical therapist. Unfortunately, 98% of patients never undergo such testing and instead undergo unnecessary and repeated diagnostic procedures and rotating trials of ineffective and costly laxatives. This is largely because high-tech testing is limited to specialty motility centers. We recently developed and prospectively validated the ability of a simple, novel point-of-care device (RED) to predict treatment outcomes with subsequent physical therapy during the initial office consultation. We propose to develop and pilot a rapid clinical care pathway anchored on a provider-facing clinical decision support tool (INTEGRATE) to facilitate adoption of RED and transform care for chronic constipation in general gastroenterology practice. The training plan aims to prepare the applicant for a career vested in transforming healthcare delivery for patients affected by GI motility disorders by developing rapid clinical care pathways that promote targeted therapy harnessing evidence-based diagnostic technology. Targeted advanced coursework will provide training in behavioral economics, user-centered design, and implementation science to facilitate these career goals. In Research Aim 1, we will conduct a needs assessment with patient and provider co-production partners to develop our intervention to nudge providers toward using RED and to facilitate related care. In Aim 2, we will evaluate the usability of our intervention to ensure that it triggers appropriately and fits within clinical workflow. In Aim 3, we will launch our intervention in a regional gastroenterology practice to evaluate its effectiveness and implementation in practice. The project will provide the necessary preliminary data for an R01 supporting a larger, randomized trial. By the conclusion of the K23, the applicant will be positioned for academic success with a niche in creating transformative clinical care pathways harnessing diagnostic technology to pull tertiary care paradigms downstream to general care settings to improve the health of patients affected by the GI motility disorders, the most common GI disorders in practice.

项目概要技术开发是 NIH 的既定目标。无数有前途的技术已经被开发出来，但很少有技术能够跨越鸿沟而被采用。很少有美国国立卫生研究院资助的研究人员接受过开发和维持变革性临床护理途径的培训，这些途径利用新颖的、基于证据的技术来改善患者的健康。这项培训补助金旨在弥补这一差距。慢性便秘是最常见的医疗投诉之一，在美国每年会导致 200 万例胃肠病转诊。对于泻药难治的症状性便秘，实践指南建议进行生理测试，以识别肛门直肠排便障碍，这些障碍通常对通常由物理治疗师提供的安全有效的骨盆康复治疗有反应。不幸的是，98% 的患者从未接受过此类测试，而是接受了不必要的重复诊断程序以及无效且昂贵的泻药的轮换试验。这主要是因为高科技测试仅限于专业运动中心。我们最近开发并前瞻性地验证了一种简单、新颖的护理点设备 (RED) 的能力，可以在初次办公室咨询期间预测后续物理治疗的治疗结果。我们建议开发和试点一个基于面向提供者的临床决策支持工具 (INTEGRATE) 的快速临床护理途径，以促进 RED 的采用并改变一般胃肠病学实践中慢性便秘的护理。该培训计划旨在通过开发快速临床护理途径，促进利用循证诊断技术的靶向治疗，为申请人的职业做好准备，为受胃肠道运动障碍影响的患者改变医疗保健服务。有针对性的高级课程将提供行为经济学、以用户为中心的设计和实施科学方面的培训，以促进这些职业目标。在研究目标 1 中，我们将与患者和提供者联合生产合作伙伴进行需求评估，以制定干预措施，推动提供者使用 RED 并促进相关护理。在目标 2 中，我们将评估干预措施的可用性，以确保其适当触发并适合临床工作流程。在目标 3 中，我们将在区域胃肠病学实践中启动干预措施，以评估其有效性和实践实施情况。该项目将为 R01 提供必要的初步数据，支持更大规模的随机试验。在 K23 结束时，申请人将在学术上取得成功，并在创建变革性临床护理途径方面占据一席之地，利用诊断技术将三级护理范例拉向下游普通护理环境，以改善受胃肠道运动障碍影响的患者的健康，实践中最常见的胃肠道疾病。