Q&A with Krishna Patel, MD, Recipient of the First IANC Research Fellowship Award

ASNC congratulates Krishna Patel, MD, who received the first Institute for the Advancement of Nuclear Cardiology (IANC) Research Fellowship Award at ASNC2018 in San Francisco. Dr. Patel will apply the $50,000 grant to her project, “Patient-centered Reporting in Myocardial Perfusion Imaging: Development and Pilot-testing a Framework for Incorporating Patient-centered Decision Support in MPI Reports.” 
Dr. Patel, a cardiology fellow at the University of Missouri-Kansas City, Saint Luke's Mid America Heart Institute, talked with ASNC about her project, her plans for the future, and her mentors. Here are excerpts from the interview:

ASNC: Congratulations on receiving the IANC's first research fellowship award for your project proposal, “Patient-centered Reporting in Myocardial Perfusion Imaging: Development and Pilot-testing a Framework for Incorporating Patient-centered Decision Support in MPI Reports.” Tell us a little about your project, please.  
Krishna Patel, MD (KP): Our project will employ a mixed-methods approach involving patient and physician stakeholders to design, implement and pilot-test patient-centered decision support tools that could be incorporated into structured MPI reports. The initial phase will employ qualitative research methods, where we will conduct patient focus groups and physician (referring physicians, cardiologists, imagers, interventionalists) surveys and panel discussions to identify their preferences regarding the information they would like in the MPI reports and how to structure it. Based on these interviews, we will develop and evaluate, in an iterative fashion, patient-centered decision support material that can be incorporated in an MPI report for common stress testing result scenarios. Once we have developed and tested the patient decision support material based on patient focus group and physician stakeholder input, we will implement and pilot-test the new MPI reports that incorporate these decision aids in patients presenting for stress MPI testing. The goal will be to identify any barriers in implementation and to test its effect on patient knowledge, engagement and satisfaction. 
ASNC: Your proposal must have struck the judges as timely and relevant for nuclear cardiology and healthcare in general? Would you comment on why your work is important now?
KP: We believe our project will create the foundation for delivering patient-centered care at the time of MPI testing by the nuclear cardiology community, help improve translation of evidence into practice and also help standardize patient care after stress testing across different practitioners. Currently, patients often don't understand a large majority of their stress test report, even when they may have access to it. Consequently, management after stress testing is often directed by the physicians with patients having little say. I strongly believe that a patient's care should be personalized and depend on his or her own personal preferences and values. The new patient-centered decision support content we aim to create with this project will help them better understand their results and reports as well as improve their involvement in decision making after their own stress tests.

As healthcare transitions to value-based reimbursement, our imaging community needs to find new ways to provide more patient-centered, high-value care that can support more effective and efficient management of patients. Any test is only as effective as the management decisions taken based on the test results. Unfortunately, studies have shown a large disconnect between test results and subsequent management, with only about half of the patients with ischemia receiving appropriate medical or invasive management. For MPI testing to maximally improve outcomes, the results should be readily interpretable to patients and physicians to help guide subsequent management. Clinical decision support tools have been shown to improve provision of recommended care for preventive and screening services but have not been applied to the generation and interpretation of MPI results. Inclusion of patient-centered decision support aids within MPI reports, which we aim to develop and pilot-test with our project, can potentially address this current gap in care by improving patient and referring physician engagement, satisfaction and adherence to recommended management strategies.

ASNC: One of the IANC's goals with the research fellowship award is to encourage the careers of promising investigators. How might receiving this prestigious award further your own career goals?
KP: I am interested in building an academic career around cardiovascular imaging and outcomes research. I strongly feel that cardiac imaging modalities, especially stress testing, if used appropriately, can be a valuable means to achieve better preventive care, reduce unnecessary resource utilization and provide care consistent with patient preferences and values. Over the past two years as a cardiology and outcomes research fellow at University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, I have worked to merge my interests in outcomes research and prevention with nuclear imaging, with a goal of identifying how best to provide patient-centered care and effect change in patient outcomes with cardiac stress testing. My IANC research award project builds on that idea and will provide me the foundational support I need to build a career as an imaging and outcomes clinician and scientist. 

ASNC: What is the timeline for the project? How might your results help today's nuclear cardiologists?
KP: We'll be implementing the project in three phases over the course of a year – development and iterative testing, system implementation and then pilot-testing of the patient-centered decision support tools. Our new reports will not only help the patients understand the results of their stress tests better and get involved in deciding their treatment, but also help improve communications among nuclear cardiologists, referring physicians and patients, and hopefully help standardize care across various practitioners. It will help maximize the benefits of stress testing and improve patient care by making it more patient-centered

ASNC: What is the long-term goal for your project?
KP: In the future, we'll expand on the work done with ASNC award by implementing the patient-centered MPI reports across multiple centers and assessing how it could improve post-test clinical decision making and help with enhancing patient-physician communication regarding the test results and subsequent management decisions. 

ASNC: Do you have mentors or colleagues who encouraged you to apply for the IANC grant?
KP: My mentors Dr. Timothy Bateman and Dr. John Spertus have supported me throughout this process and have been constant sources of inspiration and support. I have been very fortunate to learn from the very best in the fields of nuclear cardiology and patient-centered outcomes research. I hope to merge those skills and lessons to fit my career goals and make them proud.
More information about the Institute for the Advancement of Nuclear Cardiology (IANC) and its research fellowship program.