Emergency General Surgery Treatment of Older Multimorbid Patients

老年多病患者的紧急普通外科治疗

• 批准号: 10532140
• 负责人: Claire Rosen
• 金额: $ 7.62万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-23 至 2023-08-22
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10532140
• 关键词: Academic Medical Centers; Academy; Address; Adherence; Admission activity; Adult; Advocate; Affordable Care Act; Age; American; Bioethics; Cardiology; Caring; Cessation of life; Client satisfaction; Clinical; Clinical Practice Guideline; Communication; Communication Tools; Complex; Complication; Consultations; Counseling; Data; Data Analyses; Decision Making; Degree program; Destinations; Education; Elderly; Emergency Situation; Emergency department visit; Emotional; Faculty; Family; Focus Groups; Foundations; Future; Goals; Grant; Health; Health Care Costs; Health Personnel; Health Policy; Health Resources; Healthcare; Hospitalization; International; Knowledge; Laparotomy; Life; Master of Science; Medical; Medical Ethics; Medicare claim; Mentors; Methods; Operative Surgical Procedures; Outcome; Patient Care; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pennsylvania; Physicians; Population; Positioning Attribute; Procedures; Provider; Public Health; Qualifying; Quality of Care; Replicating Effective Programs; Research; Research Ethics; Research Personnel; Research Training; Resources; Risk; Science; Scientist; Structure; Surgeon; Techniques; Time; Training; United States; Universities; Work; base; burden of illness; cohort; college; comorbidity; end of life; health care service utilization; implementation framework; implementation science; improved; instrument; mortality; multidisciplinary; multiple chronic conditions; novel; older patient; operation; overtreatment; patient expectation; patient oriented; surgery outcome; tool; treatment choice; treatment planning; wasting

PROPOSAL SUMMARY/ABSTRACT Each year in the United States, there are three million emergency general surgery hospital admissions, with 30% of these patients requiring surgical intervention. Multimorbid, older patients are a complex population encompassing immense health resource utilization, but outcomes data regarding the impact of multimorbidity on older emergency general surgery patients are lacking. This limits surgeon ability to set realistic expectations for patients, which is key to enacting goal-concordant care. Patient-centered care is a national standard under the Patient Protection and Affordable Care Act and has been shown to improve health outcomes and patient satisfaction. The “Best case/Worst case” communication tool is a validated instrument to facilitate treatment choice by using scenario planning to improve patient understanding of realistic outcomes. The impact of data on the use of this tool, however, has not yet been characterized. This project will (1) define the impact of multimorbidity on outcomes for older patients requiring emergency general surgery operations using comprehensive nationwide data analysis, (2) characterize the barriers and facilitators of integrating novel data into the Best case/Worst case communication tool through focus groups and complex qualitative analysis, and (3) create an education tool kit to integrate data into using the Best case/Worst case tool using implementation science. Beyond supporting the above research, the training goal of this project is to further Dr. Claire Rosen’s training in mixed methods biomedical ethics research with a focus on patient communication, and to prepare her to become an independent investigator. The above grant will support the education of Dr. Rosen, who will pursue a Master of Science in Medical Ethics through the University of Pennsylvania Department of Medical Ethics and Health Policy. This degree program has a primary goal of training physician-scientists aspiring to empirically oriented bioethics faculty positions in academic medical centers through structured content and scientific methods coursework and mentored research. This project fills a knowledge gap regarding the outcomes of multimorbid older emergency general surgery patients and uses qualitative analysis and implementation science to improve patient-centered care and communication, striving towards national demands for higher quality care. The work will be a major step in enabling Dr. Rosen to become an independent investigator, expert in biomedical ethics, and advocate for older, multimorbid emergency general surgery patients.

提案摘要/摘要 每年在美国，有300万次紧急一般手术医院入院，有30％ 在这些需要手术干预的患者中。多重病，老年患者的人口很复杂 涵盖了巨大的健康资源利用 缺乏较老的紧急一般手术患者。这限制了外科医生设定现实期望的能力 患者，这是制定目标符合护理的关键。以患者为中心的护理是根据 患者保护和负担得起的护理法案已被证明可以改善健康结果和患者 满意。 “最佳情况/最坏情况”的通信工具是一种促进治疗的验证工具 通过使用方案计划来提高患者对现实结果的理解。数据对 但是，该工具的使用尚未表征。该项目将（1）定义 多发性趋势在需要紧急通用手术手术的老年患者的结果上 全国性的数据分析，（2）表征整合新数据的障碍和促进者 通过焦点小组和复杂的定性分析进入最佳案例/最坏情况沟通工具，并 （3）创建一个教育工具套件，将数据集成到使用实施的最佳案例/最坏情况 科学。除了支持上述研究之外，该项目的培训目标是进一步 混合方法的培训生物医学伦理学研究以患者交流为重点，并为她做好准备 成为独立研究者。上述赠款将支持罗森博士的教育，罗森博士将购买 宾夕法尼亚大学医学伦理学系医学伦理学理学硕士和 卫生政策。该学位课程的主要目标是训练有凭经验的身体科学家 通过结构化内容和科学的学术医疗中心中定向的生物伦理学 方法课程和指导研究。该项目填补了有关结果的知识差距 多训练较老的紧急通用手术患者，并使用定性分析和实施科学 为了改善以患者为中心的护理和沟通，努力满足国家对更高质量护理的需求。 这项工作将是使罗森博士成为独立研究者，生物医学专家的重要一步 伦理，并倡导较老的多重急诊紧急一般手术患者。

项目成果

The Conditional Effects of Multimorbidity on Operative Versus Nonoperative Management of Emergency General Surgery Conditions: A Retrospective Observational Study Using an Instrumental Variable Analysis.

多种发病率对紧急普通外科手术与非手术治疗的条件影响：使用工具变量分析的回顾性观察研究。

• DOI: 10.1097/sla.0000000000005901
• 发表时间: 2023
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Rosen,ClaireB;Roberts,SanfordE;Wirtalla,ChrisJ;Keele,LukeJ;Kaufman,ElinoreJ;Halpern,ScottD;Reilly,PatrickM;Neuman,MarkD;Kelz,RachelR
• 通讯作者: Kelz,RachelR

A study analyzing outcomes after bariatric surgery by primary language.

一项按主要语言分析减肥手术后结果的研究。

• DOI: 10.1007/s00464-023-10127-5
• 发表时间: 2023
• 期刊: Surgical endoscopy
• 作者: Rosen,ClaireB;Roberts,SanfordE;Sharpe,James;Gershuni,Victoria;Altieri,MariaS;Kelz,RachelR
• 通讯作者: Kelz,RachelR

Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions.

种族对急诊普通外科手术和非手术结果的条件影响。

• DOI: 10.1097/mlr.0000000000001883
• 发表时间: 2023
• 期刊: Medical care
• 影响因子: 3
• 作者: Roberts,SanfordE;Rosen,ClaireB;Keele,LukeJ;Kaufman,ElinoreJ;Wirtalla,ChristopherJ;Syvyk,Solomiya;Reilly,PatrickM;Neuman,MarkD;McHugh,MatthewD;Kelz,RachelR
• 通讯作者: Kelz,RachelR

A Novel Mobile App to Identify Patients With Multimorbidity in the Emergency Setting: Development of an App and Feasibility Trial.

• DOI: 10.2196/42970
• 发表时间: 2023-07-13
• 期刊: JMIR FORMATIVE RESEARCH
• 影响因子: 2.2
• 作者: Rosen, Claire Barthlow;Roberts, Sanford Eugene;Syvyk, Solomiya;Finn, Caitlin;Tong, Jason;Wirtalla, Christopher;Spinks, Hunter;Kelz, Rachel Rapaport
• 通讯作者: Kelz, Rachel Rapaport

Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study.

• DOI: 10.1097/xcs.0000000000000303
• 发表时间: 2022-11-01
• 期刊: Journal of the American College of Surgeons
• 影响因子: 5.2