Understanding Regional Critical Care Delivery in Acute Respiratory Failure

了解急性呼吸衰竭的区域重症监护服务

基本信息

批准号：
8819207
负责人：
David John Wallace
金额：
$ 12.68万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-12-15 至 2018-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8819207
关键词：
Acute respiratory failure Affect Algorithms Area Caring Categories Characteristics Clinical Code Critical Care Critical Illness Data Epidemiology Face Foundations Funding Future Goals Health system Healthcare Healthcare Market Home environment Hospital Mortality Hospital Referrals Hospitals Immunoglobulin Variable Region Knowledge Length of Stay Life Linear Regressions Location Logistic Regressions Measures Mechanical ventilation Medicare claim Mentors Modeling Morbidity - disease rate Outcome Patients Pattern Policy Maker Positioning Attribute Research Research Personnel Research Project Grants Research Training Resources Science Staging Statistical Models System Time Trauma Triage United States Universities Variant Work care delivery care systems career career development experience health care delivery health care quality high risk improved information system analysis innovation mortality novel patient population public health relevance skills tool

项目摘要

DESCRIPTION (provided by applicant): Acute respiratory failure requiring mechanical ventilation is an enormous clinical and financial burden on the health system, affecting over 750,000 patients in the United States each year. These patients experience substantial morbidity and mortality, particularly in small hospitals with low annual caseloads. To improve outcomes for these patients, many experts propose a regionalized approach to mechanical ventilation, analogous to the United States trauma system. Under regionalization, mechanically ventilated patients admitted to small, resource-poor hospitals would be systematically triaged to large regional referral hospitals. Regionalization has potential to save lives and increase access to high-quality critical care for patients requiring mechanical ventilation. Yet, implementation efforts face significant barriers, most notably the lack of empirical data demonstrating that centralizing care in regional hospitals of excellence actually improves outcomes. Although many studies demonstrate that mechanical ventilation outcomes are better at high-volume hospitals compared to low-volume hospitals, these studies fail to fully uncover the implications of regionalized care, which involves not only increasing case volume at some hospitals but also decreasing it at others. Prior to moving forward, clinicians and policy makers require empirical data on the implications of regionalized critical care in real-world settings. The overall goal of this project is to empirically evaluate the outcome benefit of regionalized critical care for patiets with acute respiratory failure. In Aim 1 we will define novel critical care referral regions as a geographic foundation for quantifying regional care delivery. In Aim 2 we will identify regional factors associated with greater centralization of care for acute respiratory failure. In Aim 3 we will determine the association between centralized critical care and outcomes for patients with acute respiratory failure. Completion of these Aims will both advance our knowledge of the relationship between regionalization and outcomes for acute respiratory failure, as well as provide a scientific foundation for future efforts to centralize care for other high-risk patients.The research plan will be augmented by intensive mentoring by experts in the field and didactic research training at the University of Pittsburgh and Carnegie Mellon University. Together, the research project, mentoring and coursework described herein will provide the primary investigator with essential career development in the areas of: (1) spatial epidemiology and health care geographical information systems analysis, (2) advanced hierarchical statistical modeling and (3) organizational science and health care market analysis. Ultimately, this work will set the stage for research evaluating centralized care of other time-sensitive conditions in a comprehensive R01-funded project and uniquely position the primary investigator as a future leader in the use of geographic modeling to improve outcomes for critically ill patients.

描述（由适用提供）：需要机械通气的急性呼吸衰竭是卫生系统的巨大临床和财务燃烧，每年影响750,000多名患者。这些患者的发病率和死亡率很高，特别是在年度案件较低的小型医院中。为了改善这些患者的预后，许多专家提出了一种与美国创伤系统相似的机械通气的区域化方法。在区域化下，机械通风的患者被系统地分为大型区域转诊医院。区域化有可能为需要机械通气的患者挽救生命并增加获得高质量重症监护的机会。然而，实施工作面临着重大障碍，最著名的是缺乏经验数据，表明在卓越区域医院的集中护理实际上可以改善结果。尽管许多研究表明，与低容量医院相比，高批量医院的机械通气结果更好，但这些研究未能完全揭示区域化护理的含义，这不仅涉及增加某些医院的病例量，而且还涉及其他医院的病例量。在进行前进之前，临床医生和政策制定者需要有关在现实世界中区域化重症监护的含义的经验数据。该项目的总体目标是紧急评估急性呼吸衰竭的Patiets区域化重症监护的结果益处。在AIM 1中，我们将新的重症监护转诊区域定义为量化区域护理交付的地理基础。在AIM 2中，我们将确定与更大的急性呼吸衰竭护理集中度相关的区域因素。在AIM 3中，我们将确定急性呼吸衰竭患者的集中重症监护与结果之间的关联。这些目标的完成既可以提高我们对急性呼吸道衰竭和结果之间关系之间关系的了解，又可以为将来的努力集中为其他高危患者的护理提供科学基础。该研究计划将通过该领域的专家和匹兹堡大学和卡内基大学的教育培训的专家进行强化的心理研究来增强。本文所述的研究项目，心理和课程将为主要研究者提供：（1）空间流行病学和医疗保健地理信息系统分析，（2）高级层次统计建模以及（3）组织科学和卫生保健市场分析。最终，这项工作将为研究评估对其他时间敏感条件的集中护理的研究奠定了基础全面的R01资助项目，并独特地将主要研究者定位为使用地理建模的未来领导者，以改善重症患者的预后。