Developing Implementation Science Expertise in Cardiovascular Health Services Research

PROJECT SUMMARY/ABSTRACT Management of anticoagulant medication, including for the management of low-risk pulmonary embolism, is challenging and frequently does not follow evidence-based guideline recommendations. On the one hand, up to 40% of all patients with an acute pulmonary embolism are at sufficiently low risk for complication that guidelines recommend outpatient management rather than hospitalization. However, this evidence-based practice is rarely utilized in the United States. On the other hand, when oral anticoagulants are prescribed for pulmonary embolism and other common thrombotic conditions, up to 25% of prescriptions do not follow evidence-based guidance and patients are exposed to unnecessary life-threatening risks of thromboembolism or bleeding. The research activities supported by this K24 award will complement Dr. Barnes’ ongoing NIH- funded R01 project that aims to improve the use of outpatient management of low-risk pulmonary embolism across 12 health systems in Michigan. This award also leverages Dr. Barnes’ current AHRQ R18-funded project that uses both electronic health record alerts and clinical pharmacists to improve safe- and evidence- based anticoagulant prescribing. While Dr. Barnes’ career goal is to develop, implement, and evaluate anticoagulation stewardship efforts, such as the ones being tests in his current R01 and R18 projects, he also is passionate about mentoring the next generation of patient-oriented researchers who focus on implementation science methodology. Dr. Barnes will leverage ongoing NIH R01 funded projects to expose his mentees to practical aspects of implementation science, including implementation mapping and qualitative assessments of implementation adaptation. Dr. Barnes will also focus on his own career development by gaining critical training in optimization trial design and advanced mentoring skills. Dr. Barnes has assembled a senior, diverse, and highly committed set of advisors to oversee his personal career development. He has also identified several channels for increasing his mentorship opportunities with clinician-scientists eager to develop as independent patient-oriented researchers who focus on implementation of evidence-based clinical medicine.