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Principal Investigator: Teryn Allene Holeman
Organization: UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
Fiscal Year: 2024
Award: $40,126
Funding agency: National Heart Lung and Blood Institute
ABSTRACT
Peripheral artery disease (PAD) is the one of the most common causes of morbidity and mortality for adults in
the United States. The number of patients needing surgical management for this condition is expected to nearly
double over the next 30-years. Patients with symptomatic PAD are referred to vascular surgeons who have two
potential treatment options: operative management via revascularization or non-operative management via
supervised exercise therapy. Despite symptomatic relief as the primary goal for treatment, there are no objective
outcomes used in PAD care to reflect patient’s perspective. Patient reported outcome measures (PROMs) are
validated, robust tools that objectively measure patient outcomes from the patient perspective and help deliver
patient-centered care. PROMs are used to monitor health changes across other medical conditions and contexts,
the utility of PROMs in patients with PAD has not been well-established. Traditionally, vascular surgeons have
used objective metrics, like ankle-brachial index (ABI) blood flow measurements, to evaluate progress and
determine the success of an intervention. Despite the widespread availability of PROMs, it is presently unclear
how these metrics can be used to in the clinic workflow and healthcare delivery of patients with PAD. The central
goal of this research is to develop a successful implementation strategy for PROMs as a patient voice
into routine clinical care for PAD. More specifically, we will examine how changes in physical function PROMs
and ABI influence each other dynamically over time (Aim 1.1) and then compare PROM changes over time for
physical function, depression, and social engagement in activities among operative and non-operative PAD
patients (Aim 1.2). Next, we will obtain patient perceptions and value of PROMs in PAD care using semi-
structured patient interviews (Aim 2). Finally, using a multilevel stakeholder advisory panel we will design a
strategy for implementing PROMs into routine clinical workflow for PAD patients using a modified-Delphi
approach (Aim 3). These data will provide essential contextual components (Aims 1 & 2) to help design a
successful strategy for PROMs (Aim 3) into routine clinical practice for patients with PAD. This work will lay the
foundation for future implementation efforts focused on use of PROMs at our institution and others. Our team is
uniquely qualified to carry out this research. We have prospectively collected PROMs since 2016 for research
and have the resources and clinical environment to implement changes in clinical practice. While executing these
aims, I will gain valuable knowledge using qualitative research methods, trajectory analysis, and established
implementation science frameworks. With the support of my mentorship team and the NRSA fellowship, I will
attain a unique skillset at the intersection of implementation science, surgery, and patient care that will provide
a solid foundation for future success as a vascular surgeon-scientist.
Terms: <21+ years old><65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><Achievement><Achievement Attainment><Adult><Adult Human><Aged 65 and Over><Ankle><Blood Vessels><Blood flow><Caring><Characteristics><Chronic><Clinic><Clinical><Communication><Data><Data Analyses><Data Analysis><Delphi Technic><Delphi Technique><Detection><Disease Progression><Effectiveness><Environment><Exercise Therapy><Extremities><Fellowship><Focus Groups><Foundations><Future><Goals><Health><Healthcare Delivery><Institution><Intervention><Intervention Strategies><Interview><Joints><Knowledge><Learning><Limb structure><Limbs><Managed Care><Measures><Medical><Mental Depression><Mentorship><Modeling><Monitor><Morbidity><Morbidity - disease rate><NRSA><National Research Service Awards><Non-Trunk><Operative Procedures><Operative Surgical Procedures><Outcome><Outcome Measure><Patient Care><Patient Care Delivery><Patient Outcomes Assessments><Patient Reported Measures><Patient Reported Outcomes><Patient outcome><Patient-Centered Care><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Perception><Peripheral arterial disease><Physical Function><Process><Provider><Psyche structure><QOL><Qualifying><Qualitative Research><Quality of life><Recovery><Regio tarsalis><Reporting><Research><Research Methodology><Research Methods><Research Resources><Resources><Scientist><Solid><Statistical Methods><Structure><Surgeon><Surgical><Surgical Interventions><Surgical Management><Surgical Procedure><Therapeutic exercise><Time><Training><Translating><United States><Voice><Work><above age 65><adulthood><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><blood flow measurement><care delivery><care for patients><care of patients><caring for patients><clinical care><clinical outcome measures><clinical practice><data interpretation><depression><design><designing><effectiveness/implementation hybrid><exercise treatment><future implementation><health and care delivery><health care delivery><health delivery systems><health services delivery><human old age (65+)><implementation efforts><implementation framework><implementation research framework><implementation science><implementation science framework><implementation strategy><improved><indexing><interventional strategy><measurable outcome><mental><mortality><old age><outcome measurement><over 65 years><patient oriented outcomes><peripheral artery disease><prospective><research and methods><revascularization><routine care><skills><social><social engagement><social involvement><social participation><statistic methods><strategies for implementation><success><surgery><time use><tool><treated with exercise><vascular><≥65 years>