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Principal Investigator: Premal S Trivedi
Organization: UNIVERSITY OF COLORADO DENVER
Fiscal Year: 2024
Award: $187,332
Funding agency: National Heart Lung and Blood Institute
PROJECT SUMMARY/ABSTRACT
As a vascular and interventional radiologist and a health services researcher, my long-term goal is to achieve
transformative improvements in vascular procedural care through national quality of care assessments and
implementing pragmatic inventions to improve outcomes. This research and training proposal will allow me to
gain critical skills needed to establish independence and launch a portfolio of scientific contributions focused
on systems-level quality improvement in venous thromboembolism (VTE) related care.
The goal of this research proposal is to increase timely retrieval of inferior vena cava filters (IVCF) and
improve patient outcomes in the United States. Inferior vena cava filters are very commonly placed in patients
with blood clots in the leg (deep venous thrombosis; DVT) or lungs (pulmonary embolism; PE), to prevent
propagation to the heart, which can be fatal. Unfortunately, national retrieval rates remain low and prolonged
IVCF implantation has resulted in considerable, avoidable morbidity. Multi-society guidelines recently
emphasized the need to improve timely IVCF retrieval rates through institution of structured follow up programs
and to better understand which program components are effective in real world settings. What is needed next
is identification and testing of pragmatic strategies to improve timely IVCF retrieval in real-world settings. We
propose to do this via three complimentary aims: 1) quantification of facility-level variation in IVCF retrieval
across the United States; 2) qualitative characterization of high-performing institutions to identify best practices
and characterize facilitators and barriers to their implementation; 3) design, pilot testing and iterative
adaptation of a pragmatic intervention package to improve IVCF retrieval, informed by the existing literature
and adapted with findings from aim 2. The pragmatic intervention will then be tested in multi-center hybrid
implementation-effectiveness trials to follow, with the goal of improving timely IVCF retrieval and reducing
complications across hospitals in the United States.
My training aims closely parallel the proposed research methodology through focused education in: a)
Bayesian hospital profiling, b) qualitative interviewing and analysis, and c) intervention design using an
implementation science framework. This training will be accomplished through an intentional mix of structured
coursework, formal workshop experience and one-on-one education with topical research experts.
My mentorship team and research environment at the University of Colorado Denver (UCD) are ideally
suited to this proposal. My primary mentor, P. Michael Ho MD PhD, is a national leader in cardiovascular
quality assessment and pragmatic intervention design. I will additionally leverage the extensive data and
methodologic core resources of Adult and Child Consortium for Outcomes Research and Delivery Science
(ACCORDS) and Data2Value (D2V) initiatives at the University of Colorado to accomplish these aims.
Terms: <0-11 years old><21+ years old><Abscission><Active Follow-up><Address><Adoption><Adult><Adult Human><Anticoagulant Agents><Anticoagulant Drugs><Anticoagulants><Application Context><Blood Clotting><Blood Vessels><Blood coagulation><Cardiovascular><Cardiovascular Body System><Cardiovascular Organ System><Cardiovascular system><Caring><Child><Child Youth><Children (0-21)><Clinic><Clinical><Clotting><Coagulation><Coagulation Process><Colorado><Communities><Computerized Medical Record><Data><Dedications><Deep Vein Thrombosis><Deep-Venous Thrombosis><Devices><Doctor of Philosophy><EMR tool><Education><Educational aspects><Educational workshop><Electronic Medical Record><Ensure><Environment><Excision><Extirpation><Fracture><Goals><Guidelines><Health><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Health Services><Health system><Heart><Heart Vascular><Hospitals><Implant><Inferior Vena Cava><Inferior Vena Cava Filters><Inferior vena cava structure><Informatics><Injury><Institution><Intervention><Intervention Strategies><Interview><Investigators><Lead><Leadership><Leg><Life><Literature><Lung><Lung Respiratory System><Measures><Medicare><Mentors><Mentorship><Methodology><Morbidity><Morbidity - disease rate><Nurses><Organ><Outcome><Outcomes Research><PRISM framework><PRISM model><Patient Care><Patient Care Delivery><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Patterns of Care><Pb element><Penetration><Ph.D.><PhD><Physicians><Position><Positioning Attribute><Practical Robust Implementation and Sustainability Model><Pragmatic, Robust Implementation and Sustainability Model><Process><Provider><Publishing><Pulmonary Embolism><QOC><Quality of Care><Recommendation><Removal><Reporting><Research><Research Methodology><Research Methods><Research Personnel><Research Proposals><Research Resources><Researchers><Resources><Retrieval><Safety><Science><Scientist><Societies><Structure><Surgical Removal><System><Testing><Thrombosis><Time><Title 18><Training><United States><Universities><Variant><Variation><Veins><Vena Cava Filters><Work><Workshop><acceptability and feasibility><active followup><adulthood><blood thinner><bone fracture><care for patients><care of patients><caring for patients><circulatory system><contextual factors><deep vein><design><designing><effectiveness and implementation trial><effectiveness/implementation hybrid trial><effectiveness/implementation trial><electronic medical record tool><experience><follow up><follow-up><followed up><followup><health insurance for disabled><heavy metal Pb><heavy metal lead><implantation><implementation framework><implementation research framework><implementation science><implementation science framework><improved><improved outcome><injuries><intervention design><interventional strategy><invention><kids><migration><multidisciplinary><nurse><patient oriented outcomes><pilot test><pragmatic intervention><prevent><preventing><programs><pulmonary><radiologist><research and methods><resection><skills><therapy design><thrombopoiesis inhibitor><thrombotic disease><thrombotic disorder><treatment design><vascular><venous thromboembolism><youngster>