Formative Implementation Research on Translating Evidence to Hospital Care for People Living With Sickle Cell Disease (FIRES)

PROJECT SUMMARY This is an application for a K23 Mentored Career Development Award for Dr. Ashley Jenkins, a dually trained Internal Medicine and Pediatrics (Med-Peds) hospitalist. Dr. Jenkins career goal is to become an independent researcher who uses patient-engaged approaches and implementation science to improve hospital care and

promote health equity for patients with sickle cell disease (SCD). Over 100,000 people in the US live with SCD, the majority of whom are people of color and living in poverty. People with SCD experience extremely painful vaso-occlusive episodes (VOE). VOE can be fatal, yet patients avoid hospitalization for severe VOE for the

same reasons they avoid ED visits: clinicians lack SCD knowledge, disease stigma, racial bias, and complications of health system complexity like long wait times. Care delays for severe VOE add to the risk of death. Hence, improving VOE inpatient care may not only mitigate negative healthcare experiences for

patients with SCD, but also decrease their risk of death. The NHLBI recommends use of patient-specific protocols, or individualized care plans (ICPs), for acute VOE care. ICPs include patient-specific recommendations for VOE care like pain medications. When tested in the ED setting, ICPs resulted in

improved patient experience and reduced need for hospitalization. Yet, a critical knowledge gap remains regarding how to adapt and implement ICPs tested in the emergency department for inpatient care settings. The overall objective of this K23 proposal is to use implementation strategies to adapt and preliminarily test an

ICP prototype specific for inpatient VOE care. In Aim 1, Dr. Jenkins will develop an ICP prototype adapted from the emergency department setting for inpatient SCD care with a patient-inclusive multistakeholder team. In Aim 2, she will test the feasibility of implementing and evaluating ICPs for inpatient VOE care at both a community

and university-based hospital. Dr. Jenkins’s career development plan includes formal coursework, intensive mentorship, and experiential training in 1) implementation research, 2) intervention adaptation, 3) delivering high quality SCD inpatient care, and 4) the successful conduct of multisite collaborative research. Dr. Jenkins

will be supported by the extensive resources of the University of Rochester Medical Center and Clinical and Translational Science Institute. She has also identified expert mentors in these disciplines with outstanding track records in training independent investigators and securing protected time for this work. This award

addresses a significant gap in SCD and hospital-based research while affording the education and mentored research experience critical to Dr. Jenkins and her career goal of becoming an independently funded physician-scientist.