Optimizing treatment for nursing home residents with acute cholecystitis

优化疗养院居民急性胆囊炎的治疗

• 批准号: 8630355
• 负责人: Emily Finlayson
• 金额: $ 32.34万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-15 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8630355
• 关键词: Abdomen; Acute Cholecystitis; Aftercare; Age; Antibiotic Therapy; Benefits and Risks; Cessation of life; Characteristics; Cholecystectomy; Cholecystostomy; Cholelithiasis; Cognitive; Comorbidity; Data; Data Set; Decision Making; Diagnosis; Disease; Drainage procedure; Effectiveness; Elderly; Future; Gall Bladder Diseases; Gallbladder; Geographic Locations; Health; Health Personnel; Home Nursing Care; Hospitalization; Individual; Infection; Knowledge; Life Expectancy; Medicare claim; Nursing Homes; Operative Surgical Procedures; Outcome; Patients; Pattern; Physicians; Population; Provider; Recurrence; Recurrent disease; Research; Risk; Safety; Subgroup; Therapeutic; Time; Treatment outcome; Tube; United States; Variant; Vulnerable Populations; Work; alternative treatment; base; clinical decision-making; common treatment; experience; functional decline; functional outcomes; functional status; gastrointestinal; high risk; hospital readmission; improved; innovation; medical specialties; mortality; nursing home length of stay; operation; public health relevance; standard of care; treatment strategy

Project Summary/Abstract Acute cholecystitis - infection of the gallbladder - is one of the most common gastrointestinal conditions in the United States. Removal of the gallbladder (cholecystectomy) is the only definitive treatment for acute cholecystitis. More than a third of patients with acute cholecystitis who do not undergo surgery will experience gallstone related complications within 2 years of initial diagnosis. For this reason, cholecystectomy at the time of initial episode is considered the standard of care. Whether the risks of surgery are lower than the burdens of recurrent disease in patients with limited life-expectancy is unclear. Surgical decision-making for elder nursing home residents is challenging. Our overarching research objective is to improve care for nursing home residents by providing them and their health care providers realistic information about risks and benefits of treatment for common surgical diseases. For some conditions that are usually treated surgically, the risks of surgery for nursing home residents may outweigh the burdens of future disease complications that may never occur during their remaining lifetime. [Nonsurgical] therapies such as percutaneous gallbladder drainage or antibiotic therapy alone may be more appropriate. The objective of the proposed study is to better understand the use and outcomes of surgery and [nonsurgical] therapy to treat acute cholecystitis in elder nursing home residents. To inform nursing home residents and their health care providers about risks and benefits of different treatment strategies our project has three specific aims: [1) To evaluate current treatments for acute cholecystitis among nursing home residents and determine resident and provider characteristics associated with the use of cholecystectomy and [nonsurgical] treatment, 2) to identify determinants of short term outcomes after surgery and [nonsurgical] treatment among nursing home residents with acute cholecystitis and compare the outcomes of residents undergoing surgical v nonsurgical treatment and 3) to determine the association between resident and provider characteristics and longitudinal functional outcomes, survival, and recurrent gallbladder disease after initial treatment for acute cholecystitis and compare longitudinal outcomes of residents undergoing surgical and nonsurgical treatment.] The approach is innovative because, in addition to comorbidity, we will evaluate the impact of cognitive and functional status - important and powerful predictors of life expectancy - on treatment choice and outcomes for acute cholecystitis in the entire nursing home population age 65 and older in the United States. This study is significant because currently there is no information about treatment and outcomes for this common disease in this large and vulnerable population. For individuals with limited life expectancy, determining the individualized treatment that alleviates suffering and best maintain function is essential. Better knowledge of the safety and effectiveness of alternative treatment strategies in subgroups of nursing home residents will minimize the harms of both undertreatment and overtreatment of this common disease.

项目摘要/摘要 急性胆囊炎（胆囊感染）是最常见的疾病之一 美国的胃肠道疾病。胆囊切除术（胆囊切除术）是唯一的方法 急性胆囊炎的彻底治疗。超过三分之一的急性胆囊炎患者没有 接受手术的患者将在初次诊断后 2 年内出现胆结石相关并发症。为了这 因此，初次发作时的胆囊切除术被认为是标准治疗方法。是否存在以下风险 手术是否低于复发性疾病患者的负担，有限的预期寿命尚不清楚。 老年疗养院居民的手术决策具有挑战性。我们的总体研究目标 是通过为疗养院居民及其医疗保健提供者提供现实的服务来改善对他们的护理 有关常见外科疾病治疗的风险和益处的信息。对于某些条件 通常通过手术治疗，疗养院居民的手术风险可能超过未来的负担 在他们的余生中可能永远不会发生的疾病并发症。 [非手术]疗法，例如 经皮胆囊引流或单独抗生素治疗可能更合适。该计划的目标 拟议的研究是为了更好地了解手术和[非手术]疗法的使用和结果来治疗 老年疗养院居民的急性胆囊炎。告知疗养院居民及其医疗保健 提供有关不同治疗策略的风险和益处的信息，我们的项目有三个具体目标：[1) 评估疗养院居民当前对急性胆囊炎的治疗，并确定居民和 与使用胆囊切除术和[非手术]治疗相关的提供者特征，2) 识别 疗养院居民手术和[非手术]治疗后短期结果的决定因素 患有急性胆囊炎并比较接受手术与非手术治疗的居民的结果 3) 确定居民和提供者特征与纵向功能之间的关联 急性胆囊炎初始治疗后的结果、生存率和复发性胆囊疾病并进行比较 接受手术和非手术治疗的居民的纵向结果。]该方法是创新的 因为，除了合并症之外，我们还将评估认知和功能状态的影响 - 重要 和预期寿命的有力预测因素 - 关于急性胆囊炎的治疗选择和结果 美国所有疗养院 65 岁及以上人口。这项研究意义重大，因为 目前，在这个大范围内还没有关于这种常见疾病的治疗和结果的信息。 弱势群体。对于预期寿命有限的个体，确定个体化治疗 减轻痛苦和最好地维持功能至关重要。更好地了解药物的安全性和有效性 疗养院居民亚组的替代治疗策略将最大限度地减少两者的危害 这种常见疾病的治疗不足和过度治疗。