Using Intervention Mapping and the Multiphase Optimization Strategy to develop multilevel interventions to prevent upper GI bleeding

使用干预映射和多阶段优化策略制定多级干预措施以预防上消化道出血

• 批准号: 10579295
• 负责人: JACOB ELI KURLANDER
• 金额: $ 19.44万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10579295
• 关键词: Address; Award; Behavior Therapy; Behavioral; Blood Platelets; Caring; Cessation of life; Clinical; Clinical Services; Complex; Data; Development; Economic Burden; Education; Educational Status; Effectiveness of Interventions; Elderly; Electronics; Ensure; Environment; Evaluation; Fibrinolytic Agents; Future; Gastroenterologist; Gastrointestinal Hemorrhage; Guidelines; Health; Health Promotion; Health Services Research; Health system; Healthcare; Healthcare Systems; Hemorrhage; Hospitalization; Incentives; Intervention; Intervention Studies; Interview; Intestinal Perforation; K-Series Research Career Programs; Knowledge; Measurable; Mentors; Methods; Michigan; Non-Steroidal Anti-Inflammatory Agents; Outcome; Participant; Patients; Peptic Ulcer; Perception; Pharmacists; Physicians; Pilot Projects; Prevalence; Prevention; Primary Care; Process; Proton Pump Inhibitors; Provider; Public Health Informatics; Qualitative Research; Randomized, Controlled Trials; Recommendation; Research; Research Design; Research Methodology; Research Personnel; Research Training; Risk; Risk Factors; Risk Reduction; Sampling; Site; Specialist; Structure; System; Testing; Training; United Kingdom; United States; Universities; Upper digestive tract structure; Work; acceptability and feasibility; behavior change; behavioral health; burden of illness; career; career development; contextual factors; design; experience; health care delivery; high risk; improved; informant; innovation; interest; intervention mapping; mHealth; medical specialties; medication safety; meetings; multi-component intervention; multiphase optimization strategy; next generation; participant enrollment; patient stratification; patient-level barriers; payment; pilot test; prevent; primary outcome; provider-level barriers; research and development; responsible research conduct; risk stratification; secondary outcome; skills; sound; stem; success; successful intervention; system-level barriers; theories; therapy design; therapy development; tool

PROJECT SUMMARY/ABSTRACT Candidate: Jacob E. Kurlander, MD, MSc is a gastroenterologist and early career investigator focused on reducing the burden of disease associated with upper gastrointestinal bleeding (UGIB). With prior master's- level training in clinical and health services research, he has been successful in conducting retrospective research but has little experience with formal interventional studies. This K23 mentored career development award will provide him with the unique skills necessary to design and evaluate innovative, theory-based, multilevel interventions aimed at prevention of UGIB. Research Context: Peptic ulcer disease (PUD) is a prevalent and morbid condition that can result in hemorrhage, intestinal perforation, and death. In high-risk patients, including many who use antiplatelet therapy or nonsteroidal anti-inflammatory drugs, proton pump inhibitor (PPI) gastroprotection can dramatically reduce the risk of PUD. However, fewer than half of high-risk patients receive appropriate gastroprotection. Provider-facing interventions to improve the use of gastroprotection have shown only marginal success. Multilevel interventions, targeting patients and at least two other contextual factors (e.g., providers and systems) simultaneously, are increasingly recognized as a powerful strategy to improve intervention effectiveness. However, the development and evaluation of theory- based, multilevel interventions are complex because of the multiple interacting components. Research Aims: Dr. Kurlander will leverage Intervention Mapping (IM), a validated framework for theory-based intervention development, to: (1) Develop an in-depth understanding of patient-, provider-, and system-level barriers and facilitators to appropriate PPI gastroprotection by conducting semi-structured interviews with patients, providers, and other key informants; (2) Design and produce a theory-based multilevel intervention that targets patients, providers, and the health system; (3) Assess the feasibility, appropriateness, and efficacy of the multilevel intervention in a single-site pilot study. This pilot will serve as the first step of the Multiphase Optimization Strategy (MOST), a framework for progressively preparing, optimizing, and evaluating multicomponent interventions. Training Aims: Dr. Kurlander will develop expertise in: (1) Qualitative research methods to understand contextual aspects of health care delivery; (2) Theory-based, multilevel intervention development; and (3) Evaluation and optimization methods for multilevel interventions. He also will receive specific training in the responsible conduct of research. Dr. Kurlander's training will be supported by highly experienced, interdisciplinary mentors, advanced didactic coursework, and participation in research and career development meetings/seminars within an ideal training environment. As a result of the mentored research training from this award, Dr. Kurlander will become an independent investigator uniquely skilled in the design and optimization of potent, next-generation multilevel interventions to transform the landscape of upper GI bleeding.

项目概要/摘要 候选人：Jacob E. Kurlander，医学博士、理学硕士，是一位胃肠病学家和早期职业研究者，专注于 减轻与上消化道出血（UGIB）相关的疾病负担。拥有先前的硕士学位- 在临床和卫生服务研究方面的水平培训，他成功地进行了回顾性研究 研究，但缺乏正式干预研究的经验。 K23 指导职业发展 该奖项将为他提供设计和评估创新的、基于理论的、 旨在预防 UGIB 的多层次干预措施。研究背景：消化性溃疡病（PUD）是一种 可能导致出血、肠穿孔和死亡的普遍病态。处于高风险状态 患者，包括许多使用抗血小板治疗或非甾体抗炎药、质子泵的患者 抑制剂（PPI）胃保护可以显着降低 PUD 的风险。然而，只有不到一半的高风险 患者接受适当的胃保护。面向提供者的干预措施，以改善使用 胃保护仅取得了有限的成功。多层次干预措施，针对患者，并且至少 同时，另外两个背景因素（例如提供商和系统）越来越被认为是 提高干预效果的有力策略。然而，理论的发展和评估 由于存在多个相互作用的组成部分，因此基于多层次的干预措施非常复杂。研究目的： Kurlander 博士将利用 Intervention Mapping (IM)，这是一个经过验证的基于理论的干预框架 开发，以： (1) 深入了解患者、提供者和系统层面的障碍和 通过与患者进行半结构化访谈来促进适当的 PPI 胃保护， 提供者和其他关键信息提供者； (2) 设计并制定基于理论的多层次干预措施 针对患者、提供者和卫生系统； (3) 评估方案的可行性、适当性和有效性 单点试点研究中的多层次干预。该试点项目将作为多阶段计划的第一步 优化策略（MOST），一个逐步准备、优化和评估的框架 多成分干预。培训目标：Kurlander 博士将发展以下方面的专业知识：(1) 定性 了解医疗保健服务的背景方面的研究方法； (2) 理论为本、多层次 干预发展； (3)多层次干预的评估和优化方法。他还 将接受负责任的研究行为的专门培训。 Kurlander博士的培训将得到支持 由经验丰富的跨学科导师、先进的教学课程和参与研究组成 在理想的培训环境中举办职业发展会议/研讨会。由于辅导的结果 通过该奖项的研究培训，Kurlander 博士将成为一名在以下方面具有独特技能的独立调查员 设计和优化有效的下一代多层次干预措施，以改变景观 上消化道出血。

项目成果

Identification of undocumented over-the-counter medications in an academic nephrology clinic.

在学术肾脏病诊所中识别无证非处方药。

• 发表时间: 2020
• 作者: Kokaly, Alex N;Kurlander, Jacob E;Pais, Kim;Lee, Crystal;Schaefer, Jordan K;Heung, Michael;Vordenberg, Sarah E
• 通讯作者: Vordenberg, Sarah E

Selecting the Appropriate Patients for Proton Pump Inhibitor Discontinuation: A Teachable Moment.

选择合适的患者停止使用质子泵抑制剂：一个可教导的时刻。

• 发表时间: 2019-09-01
• 影响因子: 39
• 作者: Platt, Kevin D;Saini, Sameer D;Kurlander, Jacob E
• 通讯作者: Kurlander, Jacob E

Interest in and concerns about telehealth among adults aged 50 to 80 years.

50 至 80 岁成年人对远程医疗的兴趣和担忧。

• 发表时间: 2021
• 作者: Kurlander, Jacob E;Kullgren, Jeffrey T;Adams, Megan A;Malani, Preeti N;Kirch, Matthias;Solway, Erica;Singer, Dianne C;Steppe, Emma;Saini, Sameer D
• 通讯作者: Saini, Sameer D

A survey of internists' recommendations for aspirin in older adults and barriers to evidence-based use.

一项关于内科医生对老年人服用阿司匹林的建议以及循证使用障碍的调查。

• 发表时间: 2022-11
• 影响因子: 4
• 作者: Schaefer, Jordan K;Barnes, Geoffrey D;Sussman, Jeremy B;Saini, Sameer D;Caverly, Tanner J;Read, Susan;Zikmund;Kurlander, Jacob E
• 通讯作者: Kurlander, Jacob E