PROJECT SUMMARY/ABSTRACT Diverticulosis of the sigmoid colon is a significant burden to the US health system. Complications lead to substantial morbidity and mortality. In 2004, diverticular disease was responsible for 313,000 hospitalizations, 1.9 million ambulatory care visits, and 3365 deaths in the United States. Indications for surgical management of chronic or recurrent diverticulitis are poorly understood. A number of studies have revealed that there is minimal mortality benefit to elective surgery for diverticular disease. Because of this, traditional surgical outcomes, such as 30-day survival, wound morbidity and in hospital complications are poor metrics to analyze this problem. This proposal describes a career development plan for a colorectal surgeon that will enable me to use my 75% protected effort to develop expertise in qualitative analysis, patient reported outcomes, comparative effectiveness, and analysis of longitudinal data. The research specific aims are: 1) to investigate alignment between the goals and expectations of patients and surgeons; 2) analyze the effect of surgery on the function and quality of life of patients with recurrent diverticulitis; and 3) assess the effect of surgery on health care utilization, work absenteeism and financial toxicity in recurrent diverticulitis. The career development plan integrates: a) advanced coursework and individualized mentor-directed instruction in qualitative methodology, patient reported outcomes, and surgical comparative effectiveness techniques, b) participation in local/national seminars and conferences to advance expertise in qualitative and quantitative aspects in development of patient reported outcomes, c) a multidisciplinary mentored research experience, and d) a highly supportive research environment. This environment includes the Center for Health Services Research, the Center for Surgical Quality and Outcomes Research, an AHRQ-funded Evidence- based Practice Center, a top-ranked Peabody School of Education, a Masters in Public Health program, and the Vanderbilt University Department of Surgery. Overall, this career development award will advance my ability in qualitative methods, patient reported outcomes and comparative effectiveness research by providing both didactic and experiential education under the supervision of proven mentors. We will generate important data on functional and quality of life outcomes for patients with diverticular disease. Importantly, this award provides critical support to seamlessly transition toward future independently funded studies that use patient reported outcomes to conduct comparative effectiveness studies to better understand the role of surgery in chronic disease states, including both diverticular disease and other disorders.
NIH ExPorter
NIH ExPorter