Showing 12 ideas for tag "quality"

Goal 2: Reduce Human Disease

Enhanced Pain Research in Sickle Cell Disease

There is a need for more enhanced pain research in order to help improve sickle cell disease patient outcomes and quality of life.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Pain is the most common clinical manifestation of sickle cell disease (SCD) and accounts for a large proportion of emergency department visits and hospitalizations. Due to its impact on the patients’ quality of life, there is a need for more basic and clinical research studies focused on understanding the mechanisms of different pain syndromes as well as the role of neurotransmitters and inflammation in acute and chronic SCD pain. Also, comparative effectiveness studies in the management of chronic pain will be crucial in helping to improve the patients’ overall quality of life.

Name of idea submitter and other team members who worked on this idea Alice Kuaban on behalf of the American Society of Hematology (ASH)

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39 net votes
58 up votes
19 down votes
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Goal 2: Reduce Human Disease

Improving cardiorespiratory fitness prior to hematopoietic cell transplantation

Can cardiorespiratory fitness prior to hematopoietic cell transplantation be improved and will this limit morbidity and mortality following transplantation?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

HCT is associated with high rates of morbidity and mortality from transplant-related complications. Reduction in transplant-related mortality would lead to more favorable risk/benefit assessments for the ability of transplant to cure life-threatening hematologic disorders including non-malignant conditions. Comorbidity and patient-reported functional status impairment are known to increase the risk for transplant-related mortality. Single institution studies suggest that cardiorespiratory fitness may serve a similar role as a predictive pre-transplant variable. Unlike comorbidity, cardiorespiratory fitness is potentially modifiable. However, the optimal way to improve cardiorespiratory fitness through pre-transplant exercise and lifestyle interventions is not known. Understanding how to improve cardiorespiratory fitness through a short term intervention would also benefit other health conditions relevant to the NHLBI in which future treatment is intensive and associated with significant risk.

Feasibility and challenges of addressing this CQ or CC

Understanding how to improve cardiorespiratory fitness in a short period of time will require a research agenda that addresses the following challenges: how to measure cardiorespiratory fitness in a generalized and scalable way, which may or may not require maximal exercise testing for all participants; how to design intensive exercise interventions that are at least partially home-based, in order to minimize resource burden on patients and centers; and how to personalize intervention delivery and testing in a way that is tailored to the baseline fitness levels and capabilities of each participant. Meeting these challenges will enable large-scale, personalized exercise testing and intervention delivery in other non-transplant populations.

Name of idea submitter and other team members who worked on this idea William Wood, Thomas Shea

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21 net votes
42 up votes
21 down votes
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Goal 2: Reduce Human Disease

Improving patient-centered outcome assessments in HLBS studies

What types of newer patient-centered quality of life assessment tools can be employed in heart, lung, blood and sleep studies so that they can be validated and refined to improve our measurement of quality of life outcomes in populations of interest to NHLBI?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Improving our ability to precisely measure heart, lung, blood, and sleep patients' quality of life can enable evaluation of a treatment's impact on patient-centered outcomes such as overall quality of life and its components -- pain, symptoms, and a patients' social, psychological, and physical functioning.

Feasibility and challenges of addressing this CQ or CC

New tools have been developed, notably through the PROMIS common fund project, that allow potentially more precise, reliable, valid and sensitive measurement of Q of L outcomes, with less patient burden. These tools are available but require validation in HLBS populations to allow widespread adoption and routine use in NHLBI-supported clinical trials and population studies.
Advances in biomedical science mean we are living longer with chronic diseases, and the goal of treatment increasingly focuses on disease management, maximizing function, and improving quality of life, not just lengthening life. In addition, patient-centered approaches to health care encourage a view of patients as “whole persons” with emphasis on function and capturing the "patient's voice," not just mortality/morbidity outcomes. Functional and quality of life outcomes, e.g., assessment of pain, symptoms, emotional distress, physical & social functioning, are critically important outcomes to many HLBS patients, but their measurement requires self-reports of patient experiences and thus pose challenges to precise, valid and reliable assessment.

Assessment tools using computerized adaptive testing (CAT), such as those developed in the Patient-Reported Outcomes Measurement Information System (PROMIS) project, have been shown to be precise, valid, sensitive to change and easier to administer than traditional Q of L measures in a limited number of studies, but they require validation in HLBS patient populations before they can be used more widely in NHLBI-funded studies.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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11 net votes
20 up votes
9 down votes
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Goal 3: Advance Translational Research

High Quality COPD care coordination

What factors are associated with high quality care coordination in patients with COPD?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Patients would benefit from high quality care coordination; costs to insurance companies would probably decrease as would hospitalizations; would result in better quality of life for patients.

Feasibility and challenges of addressing this CQ or CC

All providers must be willing to share information; PCP's must be willing to screen for COPD and make referrals when indicated; would be a challenge in very rural areas with very few resources.

Name of idea submitter and other team members who worked on this idea Karen Deitemeyer, COPD Foundation State Captain Program

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16 net votes
18 up votes
2 down votes
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Goal 3: Advance Translational Research

Developing adherence research to reduce unnecessary mobility/mortality/cost

From Cochrane Review NOV 20 2014
RB Haynes

“It is uncertain how medicine adherence can consistently be improved so that the full health benefits of medicines can be realized. We need more advanced methods for researching ways to improve medicine adherence, including better interventions, better ways of measuring adherence, and studies that include sufficient patients to draw conclusions on clinically important effects.”... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Effective medication exists to prevent or control most chronic diseases. The problem is that patients do not follow medical recommendations for a myriad of reasons. UNNECESSARY mortality, morbidity, poor quality of life and cost are the result of nonadherence. Intensive systematic research over a decade is the key to address the proposed challenge.

Feasibility and challenges of addressing this CQ or CC

I have developed an hypothesis, currently being examined in a controlled study by NIHLBI, that merits further evaluation. One component(J Allergy Clin Immunol: In Practice 2013;1:23) is objective measuring of asthma patients with MDI electronic monitors that need technological improvement (battery life, measure inspiration). Patients evaluated in emergency department for most chronic diseases can be objectively evaluated for adherence by assays of medication that currently are available since they exist and necessary for medication to be approved by the FDA. Other components include: coordinated identification of patient barriers; application of clinical decision support strategies to specific barriers identified; patient-centered communication skills to deliver strategies in one delivery system. Many other interventions by other researchers may also be considered during the decade.

Name of idea submitter and other team members who worked on this idea Andrew Weinstein and Asthma and Allergy Foundation of America

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5 net votes
7 up votes
2 down votes
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Goal 4: Develop Workforce and Resources

Reproducibility Initiatives in Heart, Lung and Blood Research

Scientists feel tremendous pressure to publish numerous scientific papers in order to receive NIH funding and tenure at academic institutions. Cognitive biases of scientists and publication biases of journals that publish this barrage of papers will likely result in the publication of findings that are probably not reproducible (see "Why Most Published Research Findings Are False" by John P. A. Ioannidis in PLOS Medicine... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

By distinguishing research findings which are reproducible from those which aren't, researchers will be able to build future research programs on solid scientific foundations.

There are many reasons for why research may not be reproducible, ranging from simple biological variations (cells from one supplier may behave differently than cells from a different supplier) to conscious/unconscious biases or misconduct. No matter what the underlying cause is, irreproducible research findings that are not recognized as such will result in a tremendous waste of time and resources. Graduate students or postdoctoral trainees may waste entire years of their precious training period conducting experiments that are based on published papers which may turn out to be irreproducible.

NHLBI could significantly improve the quality of research by building an infrastructure that supports the assessment of reproducibility and widely shares these findings.

Feasibility and challenges of addressing this CQ or CC

One of the challenges for assessing reproducibility of published work is that it is considered not very innovative and there is no funding available. NIH grants are awarded to highly innovative proposals which venture into new territories and not proposals which want to confirm the validity of published work. However, the returns of investing into reproducibility testing might be enormous because irreproducible results would be identified and weeded out, thus preventing loss of resources and time.

The NHLBI could develop funding mechanisms specifically designed to support research proposals that will test the reproducibility of high impact findings that have not yet been independently verified. The study sections would review these proposals using novel criteria designed for such studies. The emphasis of the study section review would lie on questions such as "Is this an important enough question that it merits reproducibility testing?" instead of the traditional "Is this a cutting-edge technology that nobody has previously used?"

Challenges would include identifying journals that would published results of these studies and agreeing on what constitutes reproducibility (i.e. is it enough if the major conclusion or effect is reproduced even though the effect size may be very different?).

Name of idea submitter and other team members who worked on this idea Jalees Rehman

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2 net votes
5 up votes
3 down votes
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Goal 2: Reduce Human Disease

Data from regulatory studies a barrier to evidence-based medicine

Alignment of regulatory, healthcare, and research arms of the government is poor. There is a need to improve the design, quality and usefulness of data from regulatory studies to address major clinical questions and also to facilitate scientific inquiry. This is a barrier to evidence based medicine and improved treatments.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea Society for Vascular Surgery

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2 net votes
3 up votes
1 down votes
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Goal 3: Advance Translational Research

The use of administrative and billing data in COPD care quality improvement

What is the validity of administrative/billing data to evaluate the quality of COPD care as part of quality improvement initiatives? What care practices can be assessed using these data?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea Nina Bracken, COPD Foundation advocate

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2 net votes
2 up votes
0 down votes
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Goal 3: Advance Translational Research

Increased assessment of the quality, integrity, and rigor of research and research reporting

In an effort to increase the quality, integrity, and rigor of research and research reporting, setting up systems for quantifying these factors across time can be accomplished. These are areas of research that can provide the field with useful feedback and serve as a basis for monitoring progress across time, journals, topics, and other factors. Hence, we propose funding the collection and publication of such monitoring... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea David B. Allison, Ph.D.; Kevin Fontaine, Ph.D.; Kathryn A. Kaiser, Ph.D.; Andrew W. Brown, Ph.D.; Edward C. Archer, Ph.D.

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1 net vote
2 up votes
1 down votes
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Goal 4: Develop Workforce and Resources

What should mentors report?

There is a need to establish markers that are predictive of future trainee success.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Instructions to Mentors for K Awards and Sponsors for F awards for reporting on the progress of their trainees in RPPR non-competitive renewal applications are very general. Developing more specific criteria and rankings should better predict future stars. Having more explicit training criteria throughout the life of a program could improve the overall quality of the mentoring and the training within the program.

Feasibility and challenges of addressing this CQ or CC

Five to ten years is sufficient time to track a representative sample of programs to develop criteria to be tested.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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-7 net votes
6 up votes
13 down votes
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Goal 3: Advance Translational Research

Quality Improvement in the ICU

How best can we engage all hospitals to participate in quality improvement initiatives to increase evidence-based practices in the ICU and other environments across diseases?

 

Is there a role for regionalization of care?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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-5 net votes
7 up votes
12 down votes
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Goal 2: Reduce Human Disease

Use Buteyko breath retraining to help patients manage and monitor their lung condition.

Buteyko Breath Retraining has been verified by the AHQR, Thorax Journal and other organizations as a legitimate technique to improve the symptoms of asthma and related respiratory illness. This simple technique could be instituted for a low cost to improve the quality of life of patients, reduce medications necessary for good control and save taxpayers and insurance companies a great deal of money.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Voting

-15 net votes
1 up votes
16 down votes
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