Candidate: Jacob E. Kurlander, MD, MSc is a gastroenterologist and early career investigator focused on reducing the burden of disease associated with upper gastrointestinal bleeding (UGIB). With prior master's- level training in clinical and health services research, he has been successful in conducting retrospective research but has little experience with formal interventional studies. This K23 mentored career development award will provide him with the unique skills necessary to design and evaluate innovative, theory-based, multilevel interventions aimed at prevention of UGIB. Research Context: Peptic ulcer disease (PUD) is a prevalent and morbid condition that can result in hemorrhage, intestinal perforation, and death. In high-risk patients, including many who use antiplatelet therapy or nonsteroidal anti-inflammatory drugs, proton pump inhibitor (PPI) gastroprotection can dramatically reduce the risk of PUD. However, fewer than half of high-risk patients receive appropriate gastroprotection. Provider-facing interventions to improve the use of gastroprotection have shown only marginal success. Multilevel interventions, targeting patients and at least two other contextual factors (e.g., providers and systems) simultaneously, are increasingly recognized as a powerful strategy to improve intervention effectiveness. However, the development and evaluation of theory- based, multilevel interventions are complex because of the multiple interacting components.
Research Aims : Dr. Kurlander will leverage Intervention Mapping (IM), a validated framework for theory-based intervention development, to: (1) Develop an in-depth understanding of patient-, provider-, and system-level barriers and facilitators to appropriate PPI gastroprotection by conducting semi-structured interviews with patients, providers, and other key informants; (2) Design and produce a theory-based multilevel intervention that targets patients, providers, and the health system; (3) Assess the feasibility, appropriateness, and efficacy of the multilevel intervention in a single-site pilot study. This pilot will serve as the first step of the Multiphase Optimization Strategy (MOST), a framework for progressively preparing, optimizing, and evaluating multicomponent interventions. Training Aims: Dr. Kurlander will develop expertise in: (1) Qualitative research methods to understand contextual aspects of health care delivery; (2) Theory-based, multilevel intervention development; and (3) Evaluation and optimization methods for multilevel interventions. He also will receive specific training in the responsible conduct of research. Dr. Kurlander's training will be supported by highly experienced, interdisciplinary mentors, advanced didactic coursework, and participation in research and career development meetings/seminars within an ideal training environment. As a result of the mentored research training from this award, Dr. Kurlander will become an independent investigator uniquely skilled in the design and optimization of potent, next-generation multilevel interventions to transform the landscape of upper GI bleeding.
Despite previous efforts, most patients at high risk for peptic ulcer disease (PUD) are not prescribed guideline- recommended and highly effective proton pump inhibitor (PPI) gastroprotection, leaving them at risk for upper gastrointestinal bleeding. Multilevel interventions are increasingly recognized as a promising strategy for addressing complex healthcare problems, such as appropriate PPI prescribing. The proposed research will use best practices in theory-based intervention development and evaluation (Intervention Mapping and the Multiphase Optimization Strategy) to design and pilot-test a multilevel intervention to improve the appropriate use of PPI gastroprotection in patients at high risk for PUD.
