Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK)

喀拉拉邦急性冠状动脉综合征质量改善 (ACS QUIK)

• 批准号: 9099883
• 负责人: Mark D Huffman
• 金额: $ 24.71万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-21 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9099883
• 关键词: Academic Detailing; Acute; Admission activity; Adrenergic beta-Antagonists; Advisory Committees; Age; Americas; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Award; Cardiology; Cardiovascular system; Caring; Cause of Death; Cessation of life; Clinical; Clinical Pathways; Clinical Trials Design; Cognitive; Complement; Control Groups; Coronary heart disease; Country; Data; Data Collection; Development; Diet; Disease; Economic Policy; Education; Educational workshop; Epidemiologic Studies; Evaluation; Event; Exercise; Family; Federal Government; Focus Groups; Foundations; Goals; Government; Guidelines; Health Personnel; Health Status; Healthcare Systems; Heart; Heart Arrest; Hemorrhage; Heparin; Hospitalization; Hospitals; Household; Income; India; Individual; Inpatients; Institutes; Insurance; International; Interview; Knowledge; Language; Lead; Learning; Measures; Mentorship; Mission; Modeling; Myocardial Infarction; National Heart, Lung, and Blood Institute; Outcome; Participant; Patients; Perception; Performance; Pharmaceutical Preparations; Platelet Glycoprotein GPIIb-IIIa Complex; Poverty; Program Evaluation; Provider; Public Health; Qualitative Research; Quality of Care; Quality of life; Questionnaires; Randomized; Recurrence; Registries; Research Ethics; Research Infrastructure; Source; Stroke; Surveys; Symptoms; System; Tobacco Use Cessation; Training; Translating; United States; United States National Institutes of Health; abstracting; acute coronary syndrome; base; burden of illness; cardiovascular disorder epidemiology; career development; clopidogrel; evidence base; follow-up; global health; group intervention; health economics; health training; healthy lifestyle; implementation science; improved; innovation; low and middle-income countries; member; novel; patient oriented; programs; research and development; satisfaction; symptom treatment; tool; treatment as usual

PROJECT SUMMARY/ABSTRACT The proposed application aims to develop, implement, and evaluate the impact of a quality improvement toolkit on 30-day major adverse cardiovascular event rates following acute coronary syndrome (ACS) through a cluster-randomized, stepped wedge clinical trial design in Kerala, India. System-level quality improvement initiatives in ACS, while successful in high-income countries, have not been extensively evaluated in low- and middle-income countries (LMIC), yet could be sources of innovation in the field of cardiovascular implementation science. This proposal will leverage the research infrastructure from the Kerala ACS Registry, which recently completed data collection from >25,000 ACS participants over the past 2 years. The proposal also contains 2 sub-studies that will evaluate the patient-level impact of ACS in Kerala, which may serve as a model for India and other LMIC. The first sub-study aims to evaluate coronary heart disease- specific quality of life following ACS using a linguistically-validated Seattle Angina Questionnaire (translated and validated from English to Malayalam, the local language of Kerala). The Seattle Angina Questionnaire surveys patients' physical limitations, symptoms, treatment satisfaction, and disease perception. The second sub-study aims to evaluate individual- and household-level impoverishing effects of an ACS event in the context of the recent implementation of a national government insurance program (Rashtriya Swathya Bima Yojna) for families below the poverty line. The proposal also includes an exploratory aim to perform qualitative research in toolkit development. This aim will incorporate focus group discussions among quality improvement team members to determine facilitators and barriers to optimal ACS care in the development of locally- developed provider-related toolkit components (clinical pathways, admission/discharge checklists, e.g.) as well as cognitive interviews with patients in the development of patient-related toolkit components (discharge education/information materials). During the career development period of this award, I will pursue patient-centered ACS registry training at St. Luke's/Mid-America Heart Institute under Dr. John Spertus, a national leader in the field. I will take courses in research ethics, program evaluation, and health economics to complement my prior training. I will participate in training workshops/pilots with Dr. Kalipso Chalkidou through NICE International, a division of the UK National Institute for Health and Clinical Excellence (NICE), to learn about the development of evidence- informed, clinical standards and guidelines adapted to local country settings and healthcare systems. I have a unique combination of public health, cardiology, and Fogarty global health training and cardiovascular epidemiology research in India that will provide a strong foundation for this project. The mentorship and advisory teams consist of US and Indian leaders in global cardiovascular epidemiology, public health, and quality care and outcomes, and will provide expert guidance for my career development and for the research itself. Relevance Development of local solutions to improving ACS care by Indian practitioners may provide innovative ideas that are relevant to and applicable in the US. As such, this proposal aims to improve the delivery of ACS care in India and capture the innovative potential of global health, a thematic goal of the NIH and part of the mission of the NHLBI.

项目摘要/摘要 拟议的应用程序旨在开发，实施和评估质量改进的影响 急性冠状动脉综合征（AC）的30天主要不良心血管事件发生率的工具包 在印度喀拉拉邦，是一项群集随机的坡度临床试验设计。系统级质量改进 ACS的倡议虽然在高收入国家成功，但在低收入和 中等收入国家（LMIC），但可能是心血管领域的创新来源 实施科学。该建议将利用喀拉拉邦ACS注册中心的研究基础设施， 在过去的两年中，该数据最近从> 25,000 ACS参与者中完成了数据收集。 该提案还包含2个子研究 可以作为印度和其他LMIC的典范。第一个子研究旨在评估冠心病 - ACS之后使用语言验证的西雅图心绞痛问卷调查的特定生活质量（翻译 并从英语到喀拉拉邦的当地语言的马拉雅拉姆语进行了验证。西雅图心绞痛问卷 调查患者的身体局限性，症状，治疗满意度和疾病感知。第二个 子研究旨在评估ACS事件在 最近实施的国家政府保险计划的背景（Rashtriya Swathya Bima yojna）适用于贫困线以下的家庭。该提案还包括进行定性的探索目的 工具包开发的研究。这个目标将在质量改进中融合焦点小组讨论 团队成员确定在当地开发中确定最佳ACS护理的促进者和障碍 - 开发的提供商相关的工具包（临床途径，入学/出院清单，例如） 随着患者与患者相关工具包的发展（出院）的认知访谈 教育/信息材料）。 在该奖项的职业发展期间，我将在以患者为中心的ACS注册表培训 该领域的国家领导人约翰·斯佩特斯（John Spertus）博士领导下的圣卢克（St. Luke）/中美洲中心研究所。我会参加课程 在研究伦理，计划评估和健康经济学方面，以补充我先前的培训。我会 通过Kalipso Chalkidou博士参加培训讲习班/飞行员，通过Nice Internation 英国国家健康与临床卓越研究所（NICE），了解证据的发展 - 适应当地国家环境和医疗保健系统的知情，临床标准和指南。 我拥有公共卫生，心脏病学和Fogarty全球健康培训以及 印度的心血管流行病学研究将为该项目奠定坚实的基础。这 指导和咨询团队由美国和印度领导人组成，全球心血管流行病学，公众 健康，优质的护理和成果，并将为我的职业发展和 研究本身。 关联 开发本地解决方案以改善印度从业者的ACS护理可能会提供创新的想法 与美国有关的并适用。因此，该建议旨在改善ACS护理的交付 在印度并捕捉全球健康的创新潜力，全球健康的目标是NIH的主题目标和任务的一部分 NHLBI。

项目成果

Acute coronary syndrome quality improvement in Kerala (ACS QUIK): Rationale and design for a cluster-randomized stepped-wedge trial.

• DOI: 10.1016/j.ahj.2016.10.026
• 发表时间: 2017-03
• 期刊: American heart journal
• 影响因子: 4.8
• 作者: Huffman MD;Mohanan PP;Devarajan R;Baldridge AS;Kondal D;Zhao L;Ali M;Lloyd-Jones DM;Prabhakaran D
• 通讯作者: Prabhakaran D

Trends in myocardial infarction secondary prevention: The National Health and Nutrition Examination Surveys (NHANES), 1999-2012.

• DOI: 10.1161/jaha.114.001709
• 发表时间: 2015-04-22
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4
• 作者: Shah NS;Huffman MD;Ning H;Lloyd-Jones DM
• 通讯作者: Lloyd-Jones DM

Cardiovascular Diseases in India Compared With the United States.

• DOI: 10.1016/j.jacc.2018.04.042
• 发表时间: 2018-07-03
• 期刊: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
• 影响因子: 24
• 作者: Prabhakaran, Dorairaj;Singh, Kavita;Roth, Gregory A.;Banerjee, Amitava;Pagidipati, Neha J.;Huffman, Mark D.
• 通讯作者: Huffman, Mark D.