Determinants of Critical Care Intensity for Hospitalized Older Adults: the Effect of Hospital-based Palliative Care Services

住院老年人重症监护强度的决定因素：医院姑息治疗服务的效果

• 批准号: 8966057
• 负责人: May Hua
• 金额: $ 17.77万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8966057
• 关键词: Academic Medical Centers; Accounting; Admission activity; Adult; Advocate; Affect; American Hospital Association; Caring; Cessation of life; Characteristics; Consultations; Critical Care; Critical Illness; Data; Data Element; Data Set; Data Sources; Development; Distress; Dose; Elderly; Ensure; Etiology; Family; Foundations; Future; Goals; Health Services Research; Hospitals; Intensive Care; Intensive Care Units; Interview; Length; Measures; Methods; Modeling; New York; Outcome; Outcomes Research; Palliative Care; Patient Preferences; Patients; Penetration; Perceived quality of life; Policies; Population; Provider; Qualitative Methods; Quality of Care; Registries; Research; Research Personnel; Resources; Risk; Sampling; Services; Structure; Surveys; Survivors; Testing; Translating; Validation; Validity and Reliability; Work; aging population; base; career; clinical care; cohort; end of life; evidence base; high risk; implementation research; improved; life-sustaining therapy; meetings; palliative; preference; programs; public health relevance; research study; response; validation studies

 DESCRIPTION (provided by applicant): The goal of the proposed studies and educational plan is to develop the PI into an independent investigator with the career goal of improving geriatric critical care through evidence-based delivery of palliative and end-of- life care for oldr adults in the intensive care unit (ICU). Older adults who are critically ill often undergo high- intensity care while simultaneously being at high-risk of death. This high-intensity treatment may result in significant discomfort and may not improve survival or be in-line with patients' preferences. The use of palliative care has been advocated as a strategy for realigning the intensity of care that is delivered with the intensity of care that is desired by patients and families. We have already demonstrated that among older adults, the need for palliative care consultation is common during high intensity treatment. In single-center studies, the use of palliative care in the ICU has been associated with markers of lower treatment intensity. However, with the recent expansion of palliative care programs, it is unclear if palliative care services have similar outcomes on a larger scale. Consequently, we plan to examine whether the availability of hospital- based palliative care services affects critical care outcomes for oldr adults by analyzing a merged multi-center data source created for this project. We will test the hypothesis that the presence of hospital-based palliative care services is associated with lower treatment intensity for critically ill older adults with three aims: 1) validate methods to study hospital-based palliative care services using administrative and proprietary data 2) determine if the availability of hospital-based palliative care services is associated with lower treatment intensity and 3) identify ICU and provider characteristics associated with high-penetration of palliative care within the ICU. We will accomplish these aims with quantitative methods, through analysis of a uniquely merged dataset of statewide hospital discharge data from New York State, data from the Annual American Hospital Association Survey and data from the National Palliative Care Registry, and with qualitative methods, using semi- structured interviews. This dataset will contain detailed information about patients and clinical care, hospital characteristic and operating characteristics of palliative care programs.

 描述（由应用程序提供）：拟议的研究和教育计划的目标是将PI开发为独立研究者，其职业目标是通过基于证据的姑息治疗和重症监护室（ICU）的老年人的姑息治疗和终止终止护理来改善老年重症监护。严重的老年人接受高强度护理，同时处于高风险死亡。这种高强度治疗可能会导致明显的不适感，并且可能不会提高生存率或与患者的偏好融为一体。已提倡使用姑息治疗作为重新调整护理强度的策略，而护理的强度则以患者和家庭所需的护理强度提供。我们已经证明，在老年人中，在高强度治疗期间对姑息治疗咨询的需求很常见。在单中心研究中，在ICU中使用姑息治疗与较低治疗强度的标记有关。但是，随着姑息治疗计划的最新扩展，尚不清楚姑息治疗服务是否在更大范围内具有相似的结果。因此，我们计划检查是否通过分析为该项目创建的合并的多中心数据源来研究基于医院的姑息治疗服务是否会影响老年人的重症监护效果。我们将检验以下假设：基于医院的姑息治疗服务的存在与患有三个目标的重症老年人的治疗强度较低：1）验证使用行政和专有数据研究基于医院的姑息治疗服务的方法2）确定基于医院的palliative护理服务是否与较低的治疗强度相关，并确定ICU和PROVIRETIAL和PRASTIRETIAL和PRAVERITAITS ICU和PRASTERITATION ICU和PRASTERITATITS ICU和PRASTERITATION与PRASTIR side ICU相关。我们将通过定量方法来实现这些目标，通过分析来自纽约州的全州医院出院数据的独特合并数据集，年度美国医院协会调查的数据以及国家姑息治疗注册表的数据以及定性方法，使用半结构访谈。该数据集将包含有关患者和临床护理，医院特征和姑息治疗计划的详细信息。