Improving Risk-Stratification in Patients with Prolonged ICU Stays

改善长期入住 ICU 患者的风险分层

基本信息

批准号：
10385749
负责人：
Elizabeth Marie Viglianti
金额：
$ 19.66万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10385749
关键词：
Accounting Achievement Admission activity American Austria Automobile Driving Award Bed Occupancy Beds Bioethics COVID-19 pandemic Caregivers Caring Chest Clinical Clinical stratification Cognitive Consult Critical Care Critical Illness Data Data Analyses Data Set Decision Making Development Development Plans Distress Ethics Event Evidence based practice Family Funding Goals Grant Healthcare Systems Hospital Mortality Hospitals Hour Institutes Intensive Care Units Interview K-Series Research Career Programs Knowledge Learned Helplessness Longitudinal Surveys Longitudinal cohort Lung Manuscripts Medical Medical center Medicine Mental Depression Mentors Methodology Michigan Minority Morbidity - disease rate National Heart, Lung, and Blood Institute North Carolina Organ failure Outcome Palliative Care Paper Patient Admission Patient Care Patients Peer Review Physicians Population Prevalence Prevention Probability Process Prognosis Prospective cohort Provider Publications Publishing Research Resources Risk SECTM1 gene Scientist Scotland Shock Societies Source Structure Survey Methodology Surveys Symptoms System Universities Validation Variant Veterans Health Administration Work Writing acute hypoxemic respiratory failure biomarker identification career career development cohort cost design evidence base experience heuristics high risk improved lecturer palliative patient stratification patient subsets prediction algorithm prevent professor prognostication prospective psychologic response risk prediction risk prediction model risk stratification social systematic review tool

项目摘要

Project Summary Candidate’s Long-Term Career Goal: To become an independently funded physician-scientist with a clinical expertise in persistent critical illness and bioethics with a methodological expertise in longitudinal surveys. Clinical Problem: Patients with prolonged ICU stays are costly, increasing in prevalence, and resulting in long-term morbidity. Unfortunately, we have not been able to identify this cohort of patients early and subsequently have not been able to institute evidence-based processes to prevent its development. Candidate Background and Achievements: Dr. Viglianti is a Lecturer in Pulmonary and Critical Care Medicine at the University of Michigan (UM). She received her MD from Duke University, MPH from the University of North Carolina Chapel Hill, and MSc from UM. To date she has published 23 papers, including 14 original peer-reviewed manuscripts; 7 of which she is first author. She won a minority grant award from the American Thoracic Society, an F32 and loan repayment award from NHLBI, and an institutional K12. Regardless of the outcome of this proposal, her department anticipates she will be appointed to an assistant professor on or before July 1, 2021, with a start-up package including $250,000 of discretionary research fund. Career Development Plan: Dr. Viglianti proposes to develop new expertise in longitudinal survey methodology and analysis, and bioethics through formal coursework and mentored research. Her primary mentor is Dr. Theodore J. Iwashyna at UM, who has mentored 7 clinician-scientists on K awards, including 4 to R-level funding. She will be co-mentored by Dr. Mick Couper a research professor at the Institute of Social Research at UM who is an expert in design and implementation of longitudinal surveys. Aims: Using both prospective and retrospective surveys and secondary data, she will 1) Determine the accuracy of physicians to prognosticate new late-onset shock and acute hypoxic respiratory failure; 2) Develop hypotheses about sources of prognostication accuracy and inaccuracy by exploring heuristics, cognitive biases and bioethical principles and values; 3) Determine the extent to which variation in hospital rates of persistent critical illness are explained by new late-onset organ failures and palliative care utilization. Deliverables from Aims: The proposed aims will lead to at least 4 publications and prepare Dr. Viglianti to write 2 R01 proposals: 1) Develop and validate a new risk-prediction tool; 2) Identification of evidence-based practices utilized by high performing hospitals in the prevention and management of late-onset organ failures.

项目概要候选人的长期职业目标：成为一名独立资助的临床科学家持续性危重疾病和生物伦理学方面的专业知识以及纵向调查的方法学专业知识。临床问题：长期入住 ICU 的患者费用昂贵，患病率不断增加，并导致不幸的是，我们无法及早识别这组患者。随后未能建立基于证据的程序来阻止其发展。候选人背景和成就： Viglianti 博士是肺部和重症监护讲师她在杜克大学获得医学博士学位，在密歇根大学获得医学硕士学位。北卡罗来纳大学教堂山分校和密歇根大学理学硕士迄今为止，她已发表 23 篇论文，其中 14 篇。原创同行评审手稿；其中 7 篇是她的第一作者，她获得了少数群体资助奖。美国胸科学会、NHLBI 的 F32 和贷款偿还奖以及机构 K12。无论这项提议的结果如何，她的部门预计她将被任命为助理于 2021 年 7 月 1 日或之前担任教授，启动方案包括 25 万美元的可自由支配研究基金。职业发展计划：Viglianti博士建议在纵向调查方面发展新的专业知识方法论和分析，以及通过正式课程和指导研究的生物伦理学。导师是密歇根大学的 Theodore J. Iwashyna 博士，他指导过 7 名临床医生科学家获得 K 奖，其中 4 名是她将得到社会研究所研究教授 Mick Couper 博士的共同指导。密歇根大学的研究人员，是纵向调查设计和实施方面的专家。目标：使用前瞻性和回顾性调查以及二手数据，她将 1) 确定医生预测新发迟发性休克和急性缺氧性呼吸衰竭的准确性；2) 发生通过探索启发法、认知偏差来假设预测准确性和不准确性的来源以及生物伦理原则和价值观； 3) 确定持续性住院率的变化程度；危重疾病的解释是新发的迟发性器官衰竭和姑息治疗的利用。目标的可交付成果：拟议的目标将导致至少 4 篇出版物，并使 Viglianti 博士做好准备编写 2 项 R01 提案：1）开发并验证新的风险预测工具；2）基于证据的识别；高性能医院在预防和管理迟发性器官衰竭方面采用的做法。