Development of a multilevel implementation intervention to prescribe evidence-based therapy for hospitalized heart failure patients

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Abstract

Candidate’s Long-Term Career Goal: To become an independently funded, leading physician-scientist focused on advancing health through multilevel implementation interventions that increase evidence-based care and improve the health outcomes of patients with heart failure. Clinical Problem: Heart failure is common, costly, and deadly. Evidence-based therapies that improve outcomes, including mortality, are not implemented adequately. Candidate Background: Dr. Cascino is a Clinical Instructor in the Division of Cardiovascular Medicine at the University of Michigan (U-M). He received an MD from Loyola University Chicago, Stritch School of Medicine and an MSc in Health and Healthcare Research from U-M. He has published 49 papers, including 38 original peer-reviewed manuscripts, 14 of which he is the first or senior author. He has been awarded four internal grants from U-M, a departmental T32, and an institutional K12. Career Development Plan: Dr. Cascino will develop new skills in health care improvement research, electronic health record (EHR) observational data analyses, mixed-methods, and implementation intervention design through a combination of intensive mentorship, didactic course work, participation in a community of scientists, progressively independent research, and on-the-job-training. Specific Aims: 1) Assess multilevel variation in guideline-directed medical therapy (GDMT) prescribing during an acute heart failure with reduced ejection fraction (HFrEF) admission, 2) Identify and prioritize determinants to promote the implementation of GDMT prescribing in the hospital setting, and 3) Design the components of a multilevel implementation intervention using implementation science methods to address prioritized determinants of inpatient GDMT prescribing. Research Plan: Dr. Cascino will employ an implementation mapping process framework to 1) use multi-health system electronic health record data from PCORnet to understand multilevel factors that are associated with variation in GDMT prescribing for admitted HFrEF, 2) use explanatory sequential mixed methods including qualitative interviews with key stakeholders to identify and prioritize determinants of GDMT prescribing, and 3) design the components of a multilevel implementation intervention targeting prioritized determinants to promote inpatient GDMT prescribing. Impact: The proposed research will advance the understanding of inpatient GDMT prescribing for patients with HFrEF and prepare Dr. Cascino to write an R-level application for a multi-site trial evaluating the implementation of a multilevel intervention to increase access to lifesaving HFrEF therapies.