ADMINISTRATIVE CORE

行政核心

基本信息

批准号：
7222397
负责人：
JONATHAN L SKINNER
金额：
$ 15.68万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-12-01 至 2011-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7222397
关键词：
Accident and Emergency department Admission activity Affect Automobile Driving Behavior Caring Case Study Chronic Disease Chronically Ill Clinical Consult Critical Illness Data Decision Making Depth Elderly Failure Family Frequencies Future Goals Health Hospitalization Hospitals Intensive Care Units Intervention Interview Knowledge Legal Length Life Marketing Measures Mediating Medical Medicare Medicine Morale Motivation Numbers Outcome Palliative Care Patient Preferences Patients Pattern Performance Phase Phase III Clinical Trials Physicians Process Provider Proxy Quality of Care Randomized Research Design Risk Safety Scientist Shadowing (Histology)Social Marketing Specialist Staging Surveys Testing Training Transcript Week base behavior change beneficiary case-based cost day design hospital utilization improved mortality multidisciplinary satisfaction social sociologist success theories tool

项目摘要

Hospitals vary markedly in the frequency and length of hospitalizations and intensive care unit (ICU) admissions and the number of specialists consulted for chronically ill Medicare beneficiaries during their last 6 months of life. The objective of our proposal is to explore this phenomenon using in-depth hospital case studies. The goal is to identify institutional and provider norms that can be changed in high intensity hospitals to improve efficiency and patient-centeredness of treatment. This would allow for an intervention at the hospital level that can improve efficiency in the sense of (a) reducing treatment intensity and costs, and (b) improving patient and family satisfaction. Our specific aims are: 1) To identify and describe the institutional and provider norms and values that influence decisions to use life-sustaining treatments (1ST) among critically ill elders with life-limiting chronic illnesses in the emergency department (ED) and the intensive care units (ICUs) of 3 high and 3 low intensity US hospitals; 2) To correlate observed intensity and norms with provider morale, family satisfaction, and hospital performance; and 3) To design and test the feasibility of one or more interventions aimed at changing practice norms correlated with poorer provider morale and/or patient and family satisfaction with care. The research design involves a physician and social scientist engaging in 4 weeks of shadow observation, informal interviews, and in-depth analysis of ED and ICU cases based upon interviews with the providers, managers, non-clinical staff, and patients or proxy decision makers involved. We will use a mixture of qualitative content analysis of field-notes and interview transcripts, guided by grounded theory, and quantitative analysis of hospital utilization and outcomes data and of provider, patient, and family survey data to develop hypotheses and to draw conclusions about the relationships between norms, intensity, and outcomes. The study-designed intervention will use social marketing tools to leverage our knowledge of the hospital staff's motivations in an effort to change norms and behavior. Examples of how we would measure success would include a reduction in the number of elders with severe limiting chronic illnesses connected to life-support and dying in the ICU.

医院在住院频率和住院时间以及重症监护病房 (ICU) 方面存在显着差异慢性病医疗保险受益人在最后一次就诊的入院人数和咨询专家的数量 6个月的生命。我们提案的目的是通过深入的医院案例来探讨这一现象研究。目标是确定在高强度医院中可以改变的机构和提供者规范以提高治疗效率和以患者为中心。这将允许干预可以提高效率的医院级别，具体体现在 (a) 降低治疗强度和成本，以及 (b) 提高患者和家属的满意度。我们的具体目标是： 1) 识别和描述影响使用决策的机构和提供者规范和价值观在紧急情况下对患有限制生命的慢性疾病的危重老年人进行生命维持治疗（1ST）美国 3 家高强度医院和 3 家低强度医院的科室 (ED) 和重症监护病房 (ICU)； 2) 将观察到的强度和规范与提供者士气、家庭满意度和医院联系起来表现;和 3) 设计并测试一项或多项旨在改变实践规范的干预措施的可行性与较差的提供者士气和/或患者和家属对护理的满意度相关。研究设计涉及一名医生和社会科学家进行为期 4 周的影子观察，非正式访谈，并根据与提供者的访谈对急诊科和重症监护室病例进行深入分析，管理者、非临床工作人员以及患者或相关决策者。我们将使用以下混合物：以扎根理论为指导，对现场笔记和访谈笔录进行定性内容分析，以及对医院利用率和结果数据以及提供者、患者和家庭调查数据进行定量分析提出假设并得出有关规范、强度和强度之间关系的结论结果。研究设计的干预措施将使用社会营销工具来利用我们的知识医院工作人员努力改变规范和行为的动机。我们如何衡量的示例成功将包括减少患有与以下疾病相关的严重限制性慢性病的老年人数量 ICU 中的生命支持和死亡。