This career development award will provide Dr. Lisa VanWagner the opportunity to develop as an independent researcher translating research into clinical practice using qualitative research methods and implementation science principles to improve cardiovascular outcomes among patients with liver disease. Dr. VanWagner will use this award to enhance her existing extensive skills in clinical epidemiology with new skills and knowledge in the application of user-centered and learning collaborative approaches and implementation science principles to optimize future uptake and adherence by multidisciplinary treatment teams of a liver transplant- specific cardiovascular disease Guideline and Care Pathway. These skills will allow her to translate epidemiologic findings into clinical practice in order to improve cardiovascular outcomes in patients with liver disease. She will achieve these career goals through a career development plan that consists of formal coursework, intensive mentorship, experiential training, and patient-oriented research. Her primary mentor is Dr. Donald Lloyd-Jones, an expert in cardiovascular disease outcomes and prevention with multiple active NIH grants and an outstanding record of mentoring. Her co-mentors include experts in healthcare quality and safety (Dr. Jane Holl), and qualitative research methods (Dr. Elisa Gordon), both with outstanding track records in training independent investigators. This will be accomplished at Northwestern University. Northwestern provides Dr. VanWagner with 1) dedicated support from the Division of Gasteroenterology and Hepatology, Department of Medicine; 2) her multidisciplinary team of mentors; 3) numerous courses and professional interactions relevant to her career development, including the Northwestern University Clinical and Translational Sciences Institute and the Institute for Public Health and Medicine; 4) research infrastructure that includes an institutional electronic data collection program and biostatistical support; and 5) extensive clinical infrastructure. The overall purpose of the research strategy is to create, implement, and test the feasibility of a Cardiovascular Disease Quality Improvement in Liver Transplantation (CVD QUILT) Care Pathway that includes a liver transplant-specific cardiovascular disease guideline, using a multidisciplinary treatment team approach. The findings of this study will target reducing cardiovascular disease in a high-risk population: patients with liver disease who have received life-saving organ transplants from scarce donated organs. The study will be conducted at a single academic hospital.
Specific Aim One will create liver transplant-specific cardiovascular disease clinical practice guidelins.
Specific Aim Two will use qualitative research methods to assess and address barriers and facilitators to the implementation and adherence to the Guideline by design and development of the CVD QUILT Care Pathway.
Specific Aim Three will test the feasibility of implementation of CVD QUILT to improve cardiovascular disease care in liver transplant recipients.

Public Health Relevance

Liver transplantation is a life-saving procedure for patients with end-stage liver disease, but survival after liver transplant is limited by preventable cardiovascular disease comorbidities and events. This project will benefit public health by developing a liver-transplant specific cardiovascular disease clinical practice guideline and then use principles of implementation science to implement the guideline in a pilot setting. The intervention developed will target improving cardiovascular disease outcomes among a high-risk population and maximize the benefit of scarce donated organs.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL136891-02
Application #
9469551
Study Section
NHLBI Mentored Patient-Oriented Research Review Committee (MPOR)
Program Officer
Coady, Sean
Project Start
2017-09-01
Project End
2021-06-30
Budget Start
2018-07-01
Budget End
2019-06-30
Support Year
2
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Northwestern University at Chicago
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
005436803
City
Chicago
State
IL
Country
United States
Zip Code
60611
Whitsett, Maureen; Wilcox, Jane; Yang, Amy et al. (2018) Atrial fibrillation is highly prevalent yet undertreated in patients with biopsy-proven Nonalcoholic Steatohepatitis. Liver Int :
VanWagner, Lisa B (2018) A simple clinical calculator for assessing cardiac event risk in liver transplant candidates: The cardiovascular risk in orthotopic liver transplantation score. Clin Liver Dis (Hoboken) 11:145-148
VanWagner, Lisa B; Kanwal, Fasiha (2018) Hepatology in a changing health care landscape: A call for health services research. Hepatology 68:1154-1162
VanWagner, Lisa B; Armstrong, Matthew J (2018) Lean NAFLD: A not so benign condition? Hepatol Commun 2:5-8
Cleveland, Erin; Bandy, Andrew; VanWagner, Lisa B (2018) Diagnostic challenges of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Clin Liver Dis (Hoboken) 11:98-104
VanWagner, Lisa B (2018) Asprin and statin use for management of atherosclerotic cardiovascular disease in liver transplant candidates: Are we missing the mark? Liver Transpl 24:865-867
VanWagner, Lisa B; Montag, Samantha; Zhao, Lihui et al. (2018) Cardiovascular Disease Outcomes Related to Early Stage Renal Impairment After Liver Transplantation. Transplantation 102:1096-1107
VanWagner, Lisa B (2018) New insights into NAFLD and subclinical coronary atherosclerosis. J Hepatol 68:890-892
VanWagner, Lisa B; Reau, Nancy (2018) Clinical Liver Disease: Introducing hot topics in hepatology. Clin Liver Dis (Hoboken) 11:33-34
Zelada, Henry; VanWagner, Lisa B; Pollack, Teresa et al. (2018) Development of a Predictive Model for Hyperglycemia in Nondiabetic Recipients After Liver Transplantation. Transplant Direct 4:e393

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