Use of systems engineering to evaluate the initiation of life-supporting treatments in older adults with life-limiting illness

使用系统工程来评估患有生命限制性疾病的老年人的生命支持治疗的启动

• 批准号: 10281269
• 负责人: Margaret Schwarze
• 金额: $ 14.27万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10281269
• 关键词: Administrator; Affect; Aging; Anthropology; Award; Behavioral; Caregivers; Caring; Clinical; Cognitive; Communication; Communication Tools; Coupled; Decision Making; Development Plans; Diagnosis; Dialysis procedure; Elderly; Engineering; Enteral Feeding; Environment; Event; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Family member; Future; Goals; Healthcare; Human; Incentives; Intervention; Interview; K-Series Research Career Programs; Laboratories; Lead; Life; Link; Mechanical ventilation; Medical; Mentors; Mentorship; Methodology; Methods; Modeling; Observational Study; Outcome; Palliative Care; Pathway interactions; Patient Care; Patient Preferences; Patients; Pattern; Patterns of Care; Play; Positioning Attribute; Process; Psychology; Quality of Care; Research; Research Personnel; Research Support; Research Training; Resources; Role; Signs and Symptoms; Surgeon; Surgical Intensive Care; Surveys; System; Technology; Testing; Time; Vascular Diseases; Work; acute care; advanced dementia; base; care systems; career; career development; clinical decision-making; comparative; driving force; end of life; end of life care; experience; financial incentive; hands on research; improved; informant; innovation; interest; novel; older patient; overtreatment; palliative; patient oriented; patient oriented research; patient population; patient safety; patient-clinician communication; practice setting; preference; programs; shared decision making; skills; social; success; therapy design; user centered design

ABSTRACT In the final six months of life older adults often receive invasive treatments despite their preferences to avoid burdensome interventions with limited efficacy. Strategies to reduce overtreatment at the end of life have focused on improving communication and decision making, yet systems-level practice patterns have a strong influence on the delivery of patient care. My patient-oriented research program focuses on improving major treatment decisions for older adults with serious illness. As a sought after mentor for early-career investigators, I now wish to expand my research program to include the human factors and systems-level forces that lead to these decisions and build a robust pipeline of researchers focused on improving care for older adults. Use of systems engineering to evaluate the initiation of life-supporting treatments in older adults with life-limiting illness is a five-year K24 Midcareer Investigator's Award in patient-oriented and aging research responding to PA-20-186. Our research team has previously recognized systems-level practice patterns leading to overtreatment and developed a conceptual model to describe this phenomenon that we call clinical momentum. We theorize that clinical momentum is a major contributor to overtreatment for older adults with life-limiting illness and is an important barrier to the success of communication interventions designed to improve care at the end of life. The objective of this proposal is to use a systems engineering approach to characterize the systems in which decisions about life-supporting treatments occur and to employ user- centered design to generate interventions to improve patient, clinician and organizational outcomes. In this observational study we will perform a comparative analysis of the initiation of life-supporting treatments, specifically dialysis, feeding tube placement, and prolonged mechanical ventilation, which will provide a rich laboratory for a variety of mentored projects. For aim 1, we will use a systems engineering approach to characterize patterns of care leading to initiation of life-supporting treatments. For aim 2, we will develop interventions to disrupt clinical momentum for older adults with life-limiting illness. This award will allow me to (1) build a new direction of research and investigative skills and (2) expand my capacity and skill as a mentor and to increase the number of young investigators who aim to develop a career in patient-oriented and aging research. This research is innovative because it uses a novel empirical strategy to identify practice patterns that may play a critical role in the provision of overtreatment for older adults with life-limiting illness. This research is significant because characterizing the role of clinical momentum in the initiation of life-supporting treatments has the potential to unlock the pathway to care truly driven by patient preferences instead of systems-level incentives and forces. With my strong mentorship team, career development plan, and the resources of existing studies I am well-positioned to achieve these objectives.

抽象的 在生命的最后六个月中 繁琐的干预措施有限。减少过度治疗在生命结束时的策略已有 专注于改善沟通和决策，但是系统级实践模式有很强的 对患者护理提供的影响。我以患者为导向的研究计划致力于改善专业 对严重疾病的老年人的治疗决定。作为早期研究人员的追捧导师， 我现在希望扩大我的研究计划，以包括导致​​的人为因素和系统级别的力量 这些决定并建立了强大的研究人员，专注于改善老年人的护理。 使用系统工程来评估老年人的生命支持治疗的开始 生命障碍疾病是五年K24中级职业研究者授予患者和衰老研究的奖项 回应PA-20-186。我们的研究团队以前已经认可了系统级实践模式 导致过度治疗并开发了一个概念模型来描述我们称之为临床的现象 势头。我们认为临床动量是使老年人过度治疗的主要因素 生命中的疾病，是旨在成功的沟通干预措施成功的重要障碍 改善生命结束时的护理。该提案的目的是使用系统工程方法来 表征有关生命支持治疗的决定并雇用用户的系统 - 集中的设计，以产生干预措施，以改善患者，临床医生和组织成果。在这个 观察性研究我们将对生命支持治疗的开始进行比较分析， 特别是透析，进食管的放置和延长的机械通气，这将提供丰富的 各种受过指导项目的实验室。对于AIM 1，我们将使用系统工程方法来 表征护理模式导致生命支持治疗的启动。对于目标2，我们将发展 破坏患有生命疾病的老年人的临床动量的干预措施。 该奖项将使我（1）建立一个新的研究和调查技能方向，（2）扩展我 作为导师的能力和技巧，并增加了旨在发展职业的年轻调查员的数量 在面向患者的研究和衰老研究中。这项研究具有创新性，因为它使用了一种新颖的经验策略 确定可能在为老年人提供过度治疗的练习模式 生命疾病。这项研究很重要，因为表征了临床动量在 生命支持治疗的开始有可能解锁患者驱动的护理途径 偏好而不是系统级的激励和力量。我的强大指导团队，职业 开发计划以及现有研究的资源，我善于实现这些目标。