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: 10482359
• 负责人: Margaret Schwarze
• 金额: $ 14.25万
• 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/10482359
• 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，老年人经常接受侵入性治疗，尽管他们倾向于避免 繁重的干预措施效果有限。减少临终过度治疗的策略 专注于改善沟通和决策，但系统级实践模式具有很强的 对患者护理服务的影响。我以患者为中心的研究计划侧重于改善专业 患有严重疾病的老年人的治疗决定。作为早期职业研究人员追捧的导师， 我现在希望扩大我的研究计划，以包括导致​​以下问题的人为因素和系统级力量： 这些决定并建立了一个强大的研究人员队伍，专注于改善对老年人的护理。 使用系统工程来评估老年人生命支持治疗的启动 限制生命的疾病是一项为期五年的 K24 Midcareer Investigator's Award，以患者为导向和老龄化研究 响应 PA-20-186。我们的研究团队之前已经认识到系统级的实践模式 导致过度治疗，并开发了一个概念模型来描述这种现象，我们称之为临床 势头。我们的理论是，临床动力是老年患者过度治疗的主要原因 限制生命的疾病，是旨在实现沟通干预措施成功的重要障碍 改善临终关怀。该提案的目标是使用系统工程方法 描述做出有关生命支持治疗的决策的系统的特征，并采用用户 以中心设计产生干预措施，以改善患者、临床医生和组织的结果。在这个 观察性研究我们将对生命支持治疗的启动进行比较分析， 特别是透析、饲管放置和长时间机械通气，这将提供丰富的 各种指导项目的实验室。对于目标 1，我们将使用系统工程方法来 描述导致开始生命支持治疗的护理模式。对于目标2，我们将开发 干预措施破坏患有生命限制性疾病的老年人的临床动力。 该奖项将使我能够 (1) 建立新的研究方向和调查技能，以及 (2) 扩展我的研究领域 作为导师的能力和技能，并增加旨在发展职业生涯的年轻研究人员的数量 以患者为导向和老龄化研究。这项研究具有创新性，因为它使用了新颖的实证策略 确定可能在向患有老年痴呆症的老年人提供过度治疗方面发挥关键作用的实践模式 限制生命的疾病。这项研究意义重大，因为描述了临床动量在 启动生命支持治疗有可能开启真正由患者驱动的护理途径 偏好而不是系统级的激励和力量。凭借我强大的导师团队，我的职业生涯 发展计划以及现有研究的资源我完全有能力实现这些目标。