Optimizing Quality in Noninvasive Cardiovascular Testing

优化无创心血管检测的质量

基本信息

批准号：
10579945
负责人：
Vinay Kini
金额：
$ 16.74万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-05 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10579945
关键词：
Administrator Affect Area Award Biometry Cardiovascular Diseases Cardiovascular system Caring Characteristics Clinical Clinical Practice Guideline Collaborations Colorado Coronary Data Data Analyses Data Collection Diagnostic tests Doctor of Philosophy Echocardiography Effectiveness Ensure Environment Failure Funding Future Goals Grant Growth Health Care Quality Assessment Healthcare Heart failure Hospitalization Hospitals Incentives Institution Interview Knowledge Link Medical Mentors Mentorship Methodology Methods Modeling Myocardial Infarction Online Systems Outcomes Research Patient Care Patient-Focused Outcomes Patients Performance Physicians Preparation Procedures Process Provider Publications Qualitative Methods Quality of Care Research Research Methodology Research Personnel Research Proposals Resources Secure Stress Tests Structure Survey Methodology Surveys Testing Time Training Universities Variant Vascularization acute care candidate identification career cost data infrastructure data management dissemination research effectiveness research evidence base hands on research health care quality heart function hospital care improved informant instrument medical schools multidisciplinary multimodality novel pilot test programs shared decision making skills support tools surgical risk

项目摘要

Project Summary / Abstract My long-term career goal is to be a national leader in cardiovascular quality and effectiveness research by systematically building a research portfolio on optimizing the use of noninvasive cardiovascular tests (NCT). This research and training proposal will enable my transition into an independent physician investigator. The goal of the research proposal is to optimize NCT quality by reducing underuse and overuse of NCT. Clinical practice guidelines define scenarios where use of NCT is rated “must-do” (improves patient outcomes) or “rarely appropriate” (provides no net benefit to patients). However, rates of must-do NCT are suboptimal and rates of rarely appropriate NCT remain high, leading to adverse patient outcomes. We propose to use the positive deviance approach to optimize NCT quality: by identification and in-depth study of hospitals that demonstrate exceptional quality (positive outliers), we will identify best practices that could lead to national improvements in NCT quality. We will 1) identify and characterize hospital outliers in use of four major “must- do” and “rarely appropriate” NCT using claims data, 2) interview key informants at positive outlier hospitals to understand and identify processes and structures of care that affect NCT quality, and 3) develop and pilot a hospital survey to determine the presence of these care processes. In a subsequent R01 we will survey hospitals nationally; link data on hospital NCT use to correlate care processes with NCT quality; and disseminate evidence-based “best practices” to optimize NCT quality and improve patient outcomes. My training objectives proceed in a logical fashion with my research aims to prepare me for the transition to an independent research career in NCT quality. These include: 1) acquiring expertise in three common methods of healthcare quality assessment (multilevel regression modeling, qualitative methods, and survey methods); 2) conducting practical research identifying strategies to optimize use of NCT; and 3) developing the skills necessary for effective dissemination of research findings and securing independent research funding. I will accomplish these training objectives through formal coursework, guidance from my mentors, attendance at seminars, and hands-on research with publication of findings. This multi-modal approach will enable me to acquire new knowledge in areas critical to achieving my career goals, implement the proposed research plan, and build an independent research program with the ultimate goal of receiving R-level funding. The environment at the University of Colorado Denver (UCD) is uniquely equipped to support my training needs. My primary mentor is P. Michael Ho, MD, PhD, a nationally recognized leader in cardiovascular quality and outcomes research with a proven track record of mentorship and securing grant support. My multidisciplinary mentoring team includes both methodologic and content experts that are highly relevant to my research and training goals. The practical resources of the School of Medicine and the Outcomes Research Center at UCD provide an extensive infrastructure for data management and biostatistical support.

项目概要/摘要我的长期职业目标是成为心血管质量和有效性研究的全国领导者系统地建立优化无创心血管测试（NCT）使用的研究组合。这项研究和培训计划将使我能够转变为一名独立的医师调查员。该研究提案的目标是通过减少 NCT 使用不足和过度使用来优化 NCT 质量。临床实践指南定义了 NCT 的使用被评为“必须做”的场景（改善患者治疗结果）或“很少合适”（不会给患者带来净效益）。然而，必须做的 NCT 比率并不理想，而且很少适当的 NCT 率仍然很高，导致患者出现不良结果。优化 NCT 质量的积极偏差方法：通过对以下医院的识别和深入研究表现出卓越的品质（积极的异常值），我们将确定可能导致全国性的最佳实践我们将 1) 使用四个主要“必须-”来识别和描述医院异常值。使用索赔数据“做”和“很少合适”NCT，2) 采访阳性异常值医院的关键知情人，以了解了解并确定影响 NCT 质量的护理流程和结构，以及 3) 开发和试点医院调查以确定这些护理流程的存在在随后的 R01 中，我们将进行调查。全国医院；链接医院 NCT 使用数据，将护理流程与 NCT 质量关联起来；传播基于证据的“最佳实践”，以优化 NCT 质量并改善患者治疗结果。我的培训目标以合乎逻辑的方式进行，我的研究旨在为我的过渡做好准备 NCT 质量的独立研究生涯包括：1) 获得三个常见领域的专业知识。医疗质量评估方法（多级回归模型、定性方法和调查 2) 开展实际研究，确定优化 NCT 使用的策略；以及 3) 开发有效传播研究成果和获得独立研究资金所需的技能 I。将通过正式课程、导师的指导、参加这种多模式方法将使我能够获取对实现我的职业目标至关重要的领域的新知识，实施拟议的研究计划，并建立一个独立的研究项目，最终目标是获得R级资助。科罗拉多大学丹佛分校 (UCD) 的环境拥有得天独厚的条件来支持我的培训我的主要导师是 P. Michael Ho，医学博士、博士，他是全国公认的心血管质量领域的领导者。和成果研究，具有良好的指导和获得资助支持的记录。多学科指导团队包括与我高度相关的方法论和内容专家研究和培训目标。医学院的实践资源和成果研究。都柏林大学中心为数据管理和生物统计支持提供广泛的基础设施。

项目成果

期刊论文数量（12）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association.

减少低价值心血管护理的策略：美国心脏协会的科学声明。

DOI：
发表时间：
2022-03
期刊：
影响因子：
0
作者：
Kini, Vinay;Breathett, Khadijah;Groeneveld, Peter W;Ho, P Michael;Nallamothu, Brahmajee K;Peterson, Pamela N;Rush, Pam;Wang, Tracy Y;Zeitler, Emily P;Borden, William B;American Heart Association Council on Quality of Care and Outcomes Research
通讯作者：
American Heart Association Council on Quality of Care and Outcomes Research

Trends in High- and Low-Value Cardiovascular Diagnostic Testing in Fee-for-Service Medicare, 2000-2016.

2000-2016 年按服务收费医疗保险中高价值和低价值心血管诊断测试的趋势。

DOI：
发表时间：
2019
期刊：
影响因子：
13.8
作者：
Kini, Vinay;Viragh, Timea;Magid, David;Masoudi, Frederick A;Moghtaderi, Ali;Black, Bernard
通讯作者：
Black, Bernard

Physicians' Attitudes and Experiences with Medical Aid in Dying in Colorado: a "Hidden Population" Survey.

科罗拉多州医生对死亡医疗援助的态度和经验：“隐藏人口”调查。

DOI：
发表时间：
2022-10
期刊：
影响因子：
5.7
作者：
Campbell, Eric G;Kini, Vinay;Ressalam, Julie;Mosley, Bridget S;Bolcic;Lum, Hillary D;Kessler, Elizabeth R;DeCamp, Matthew
通讯作者：
DeCamp, Matthew

Toward Patient-Centered Healthcare Value.

实现以患者为中心的医疗保健价值。

DOI：
发表时间：
2019
期刊：
影响因子：
0
作者：
Kini, Vinay;Michael Ho, P
通讯作者：
Michael Ho, P

A novel methodology to identify and survey physicians participating in medical aid-in-dying.

一种识别和调查参与医疗救助的医生的新颖方法。

DOI：
发表时间：
2022-04-11
期刊：
影响因子：
4.6
作者：
Kini, Vinay;Mosley, Bridget;Ressalam, Julie;Bolcic;Lum, Hillary D;Kessler, Elizabeth R;DeCamp, Matthew;Campbell, Eric G
通讯作者：
Campbell, Eric G