ICU Discharge: A Critical Juncture for Survivors of Acute Respiratory Failure

ICU 出院：急性呼吸衰竭幸存者的关键时刻

• 批准号: 8263375
• 负责人: Sydney Elizabeth Sherman Brown
• 金额: $ 2.86万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8263375
• 关键词: Acute; Acute respiratory failure; Adherence; Affect; Anxiety; Award; Beds; Bioethics; Biometry; Caring; Censuses; Cessation of life; Clinical; Communication; Complement; Continuity of Patient Care; Coupled; Critical Care; Critical Illness; Data; Databases; Doctor of Philosophy; Dyspnea; Elements; Eligibility Determination; Epidemiology; Faculty; Floor; Foundations; Future; Goals; Grant; Health Services Research; Hospital Mortality; Hospitals; Hypoxemia; Institution; Intervention; Intervention Studies; K-Series Research Career Programs; Learning; Measures; Mechanical ventilation; Medical; Medical Care Team; Mental Depression; Mentors; Methods; Modeling; Monitor; Morbidity - disease rate; Outcome; Outcomes Research; Patient Discharge; Patients; Phase; Physicians; Postdoctoral Fellow; Qualitative Methods; Recommendation; Relative (related person); Research; Research Personnel; Research Training; Risk; Scientist; Staging; Statistical Methods; Students; Survey Methodology; Surveys; Survivors; Telephone Interviews; Testing; Time; Training; Triage; Trust; Vulnerable Populations; Work; adverse outcome; base; clinical decision-making; clinical epidemiology; cohort; coping; design; improved; instrument; meetings; pressure; prospective; psychologic; psychological outcomes; public health relevance; satisfaction; time use

DESCRIPTION (provided by applicant): This training grant is being sought by an MD-PhD student preparing to enter the dissertation phase of her PhD in clinical epidemiology. The candidate aspires to become a leading independent physician-scientist in the field of critical care outcomes research. She will devote 100% of her time to this research for the duration of her PhD. Her hands-on training during her dissertation phase, coupled with carefully selected didactic courses, are designed to make her expert in the use of advanced statistical methods to define associations between critical care exposures and outcomes as well as in the use of qualitative methods to deeply explore mechanisms and generate new hypotheses. This dual training approach will optimally prepare her for future studies on doctor-patient communication during transitions of care for critically ill patients. Throughout this award, she will be mentored by senior experts in health services research, critical care, biostatistics, bioethics, and qualitative methods. The research portion of this career development award will proceed in three complimentary projects to improve understanding of how the circumstances surrounding ICU discharge affect the outcomes for acute respiratory failure (ARF) patients and their surrogates. In project 1, the candidate will examine the effect of ICU census on the medical outcomes of ARF patients using a national database of ICU patients. First, she will evaluate the effect of ICU census on the time between extubation and ICU discharge for ARF patients requiring mechanical ventilation. She will then examine the relationship between ICU census and in-hospital death and ICU readmission, investigating whether time between extubation and ICU discharge acts as an effect modifier between census and negative outcomes. In project 2, she will prospectively collect data to examine psychological and trust outcomes patients who suffered an episode of ARF requiring mechanical ventilation and their surrogates. She will conduct telephone interviews with patients and surrogates one month following ICU discharge and administer validated surveys that assess anxiety, depression, and trust outcomes. This research will therefore produce valid measures of the previously unexplored risks surrounding the time of discharge to ARF patients requiring mechanical ventilation and their surrogates. It will build the foundations of a conceptual model that will be used as the basis for future qualitative studies that examine the content of conversations between the health care team and patients and surrogates at the time of ICU discharge to determine which communication elements patients and surrogates find most helpful. The ultimate goal is to improve outcomes in this vulnerable group of patients and surrogates with future intervention studies targeting bed allocation decisions and communication between the health care team and patients and surrogates. PUBLIC HEALTH RELEVANCE: The timing and circumstances of discharge from the ICU may be critical determinants of longer-term outcomes for patients surviving an episode of acute respiratory failure and their surrogates. Using quantitative and survey methods, this research will identify circumstances surrounding ICU discharges that portend adverse clinical outcomes, thereby elucidating targets for interventions to improve care for this vulnerable group of patients and their surrogates.

描述（由申请人提供）：准备进入临床流行病学博士学位的博士学位阶段的MD-PHD学生正在寻求这项培训补助金。候选人渴望成为重症监护结果研究领域的领先独立医师科学家。在博士学位期间，她将将100％的时间用于这项研究。她在论文阶段的动手训练以及精心选择的教学课程的旨在使她在使用先进的统计方法方面的专家来定义重症监护暴露与结果之间的关联以及使用定性方法，以深入探索机制并产生新的假设。这种双重训练方法将为她提供最佳的准备，以便在针对危重患者的护理过渡期间对医生沟通的未来研究做好准备。在整个奖项中，她将受到卫生服务研究，重症监护，生物统计学，生物伦理学和定性方法的高级专家的指导。该职业发展奖的研究部分将在三个免费项目中进行，以提高对ICU出院情况如何影响急性呼吸衰竭（ARF）患者及其代理的结果。在项目1中，候选人将使用国家ICU患者数据库研究ICU人口普查对ARF患者的医疗结果的影响。首先，她将评估ICU普查对需要机械通气的ARF患者拔管和ICU出院时间之间的时间的影响。然后，她将研究ICU人口普查与院内死亡与ICU再入院之间的关系，并研究拔管和ICU放电之间的时间是否起到人口普查和负面结果之间的效果修饰符。在项目2中，她将预先收集数据，以检查遭受机械通气及其代理的ARF发作的心理和信任结果。她将对患者进行电话采访，并在ICU出院后一个月进行替代，并管理经过验证的调查，以评估焦虑，抑郁和信任结果。因此，这项研究将对需要机械通气及其替代物的ARF患者的出院时间围绕着以前未开发的风险产生有效的措施。它将建立一个概念模型的基础，该模型将被用作未来定性研究的基础，该研究检查医疗团队与患者之间的对话内容以及在ICU出院时的代理人之间的对话内容，以确定哪些沟通元素患者和代理人发现最有帮助。最终目标是改善这一脆弱的患者组的结果，并通过针对床位分配决策的未来干预研究以及卫生保健团队与患者和代理人之间的沟通进行替代研究。 公共卫生相关性：从ICU中出院的时间和情况可能是生存急性呼吸衰竭及其代理的患者长期结局的关键决定因素。使用定量和调查方法，这项研究将确定围绕ICU排放的情况，这些情况将放置不良临床结果，从而阐明了干预措施的靶标，以改善对这一脆弱的患者及其代理人的护理。