End of Life Preferences and Healthcare Resource Use in Heart Failure Patients

心力衰竭患者的临终偏好和医疗资源使用

基本信息

批准号：
9321419
负责人：
Shannon Marie Dunlay
金额：
$ 17.09万
依托单位：
MAYO CLINIC ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-20 至 2018-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9321419
关键词：
Acute Address Advance Care Planning Advisory Committees Advocate Affect Area Award Cardiovascular system Caring Cessation of life Characteristics Chronic Chronic Disease Client satisfaction Clinic Clinical Investigator Clinical Research Collaborations Communication Communities Comprehensive Health Care Consultations County Data Data Analyses Databases Dedications Development Disease EFRAC Economic Burden Emergency department visit Enrollment Ensure Environment Epidemiology Event Expenditure Exposure to Fostering Foundations Frequencies Funding Future Gills Goals Guidelines Health Care Reform Health Services Health Services Research Healthcare Healthcare Systems Heart failure Hospitalization Individual Influentials Knowledge Lead Left Ventricular Function Life Measures Medical Medicare Medicine Mentored Patient-Oriented Research Career Development Award Mentors Mission Modeling Morbidity - disease rate National Heart, Lung, and Blood Institute Outcome Outcome Measure Outcomes Research Outpatients Palliative Care Palliative Medicine Paper Patient Care Patient Preferences Patients Performance Phenotype Physicians Positioning Attribute Process Provider Public Health Publishing Quality of life Questionnaires Recommendation Recruitment Activity Research Research Design Research Infrastructure Research Personnel Resources Resuscitation Risk Science Services Surveys Syndrome Techniques Training Work base career cohort cost end of life end of life care experience frailty health care delivery health care disparity health care service utilization hospice environment improved meetings mortality outcome forecast patient oriented patient oriented research population based preference prospective shared decision making skills symposium tool working group

项目摘要

DESCRIPTION (provided by applicant): Dr. Dunlay is a cardiologist specializing in the care of patients with heart failure (HF). Her long term goal is to become an independent health services and outcomes researcher in the field of HF. Her short term goal is to strengthen her research expertise and add new skills becoming proficient in the tools necessary to perform this type of research. Key components of her training plan during the K23 period include: * Adding to her existing skill set by doing the following: o Enhancing health services research knowledge through coursework o Mastering use of advanced data analysis techniques through coursework and practice o Expanding her knowledge of resources available to outcomes researchers o Developing end of life and survey research content expertise * Fostering existing and developing new collaborative relationships by presenting her work at national conferences, applying for participation in Early Career Committees, and working with internal and external experts in health services and outcomes research. * Publishing high impact results: Dr. Dunlay will publish 5 senior author papers resulting from the proposed aims and be a co-author on at least 8 additional papers demonstrating evidence of successful collaboration * Obtain RO1 level funding: Dr. Dunlay will submit RO1 proposals during the 3rd and 5th years of the award Dr. Dunlay is highly committed to making the successful transition to an independent clinical investigator during the K23 award period. The receipt of this award is critical to her attaining he goals. ENVIRONMENT The Mayo Clinic has a longstanding dedication to patient-centered medicine and patient-oriented research. Through its comprehensive infrastructure, the Mayo Clinic is both committed and highly capable of training physician investigators who will become future leaders in cardiovascular research. The Mayo Clinic has identified health services and outcomes research as an area of critical need and an institutional priority, as evidenced by the recent development of the Center for the Science of Healthcare Delivery, directed by Dr. V ronique Roger, mentor of this proposal. Dr. Dunlay has assembled a Career Advisory Committee of established experts and experienced mentors who are fully committed to her development into an independent clinical investigator during the K23 award period. Finally, these studies will be conducted under the auspices of the Rochester Epidemiology Project (REP), which provide a unique well-established framework for the performance of community-based health services research such as is being proposed herein. In summary, the institutional environment and mentoring team will ensure Dr. Dunlay's successful transition toward an independent career in health services and outcomes research. RESEARCH Background: Patients with advanced HF have high healthcare resource utilization including repeated hospitalizations that adversely affect their quality of life and are a major public health problem. However, it is unknown how end of life patient preferences and advance care planning contribute to differences in healthcare resource use in advanced HF. We will address these gaps in knowledge through the proposed studies. Specific Aims: First, we will examine healthcare utilization at the end of life and how it may be impacted by the type of HF (HFpEF, HFrEF), frailty, and use of palliative care and hospice services (Aim 1). Next, we will investigate how often advance care planning including patient-provider conversations regarding end of life occur (Aim 2). Finally, we will determine whether advance care planning and patient preferences contribute to differences in healthcare resource use, including hospitalizations (Aim 3). Study Design and Outcome Measures: The studies will be conducted in Olmsted County, MN under the auspices of the REP. First, among a population-based cohort of patients with HF who were prospectively enrolled into a study of the mentor of this proposal from 2003-2012, we will examine healthcare resource utilization (hospitalizations, outpatient and emergency department visits) in the last 6 months of life among those who died. Using Andersen-Gill models which account for repeated events, the risk of hospitalization at the end of life will be examined by type of HF (HFpEF vs. HFrEF) and frailty, adjusting for potential confounders. Differences in healthcare use among those who received palliative medicine consultation and hospice services will also be examined. Second, we will prospectively recruit consecutive Olmsted County residents hospitalized with HF and assess their end of life preferences and involvement in advance care planning using a face-to-face questionnaire and compare differences by type of HF and frailty. Finally, the enrolled patients will be followed and the association between end of life preferences and healthcare resource use will be determined using Andersen-Gill models. Potential Public Health Contribution: Data on end of life preferences in advanced HF and their association with resource utilization are lacking. The proposed aims will address these critical gaps in knowledge, thereby informing us on potential disparities in the care of HF patients that may be interfering with the shared decision- making process and, if improved, may lead to a reduction in hospitalizations and improved patient satisfaction Relationship to the NHLBI Mission: These studies aim to determine ways to properly assess and treat patients with HF so that they can live more fulfilling lives, in alignment with th NHLBI mission statement. Relationship to the Career Goals of the Candidate: The proposed studies will provide necessary advanced exposure to the performance of population-based health services research in HF and will be the foundation for the candidate to establish a career in HF health services and outcomes research.

描述（由申请人提供）：Dunlay博士是一名心脏病专家，专门研究心力衰竭患者（HF）。她的长期目标是成为HF领域的独立卫生服务和成果研究员。她的短期目标是增强她的研究专业知识，并添加新技能熟练精通执行此类研究所需的工具。 K23期间她的培训计划的关键组成部分包括： *通过执行以下操作来增加她现有的技能： o通过课程增强健康服务研究知识 o通过课程和练习来掌握高级数据分析技术 o扩大她对结果可用资源的了解 o发展生命的尽头和调查研究内容专业知识 *通过在国家会议上介绍她的工作，申请参加早期职业委员会，并与内部和外部专家在卫生服务和成果研究方面合作，从而促进现有和发展新的合作关系。 *发布高影响力结果：Dunlay博士将发表5个高级作者论文，这是由拟议的目标产生的，并成为至少8份其他论文的合着者，证明了成功合作的证据 *获得RO1级资金：Dunlay博士将在奖励的第三年和第5年提交RO1提案 Dunlay博士高度致力于在K23奖励期间成功过渡到独立的临床研究者。收到该奖项对于她实现目标至关重要。环境Mayo诊所对以患者为中心的医学和以患者为中心的研究有长期的奉献精神。通过其全面的基础设施，Mayo诊所既致力于培训医师研究人员，他们将成为心血管研究的未来领导者。梅奥诊所已将卫生服务和成果研究确定为迫切需要和机构优先事项的领域，这是由该提案的导师V Ronique Roger博士指导的最新发展中心医疗保健提供中心的发展。邓莱（Dunlay）博士已组建了一个职业咨询委员会，由成熟的专家和经验丰富的导师组成，他们在K23奖项期间完全致力于将自己的发展成为独立的临床研究者。最后，这些研究将在罗切斯特流行病学项目（REP）的主持下进行，该项目为基于社区的卫生服务研究提供了独特的框架，例如本文提出的。总而言之，机构环境和指导团队将确保邓莱博士成功地过渡到卫生服务和成果研究领域的独立职业。研究背景：高级HF患者具有高度医疗保健资源的利用，包括反复的住院治疗，从而不利地影响其生活质量，并且是一个主要的公共卫生问题。但是，尚不清楚患者的偏好和预先护理计划如何导致高级HF中医疗保健资源使用的差异。我们将通过拟议的研究来解决知识中的这些差距。具体目的：首先，我们将检查生命尽头的医疗保健利用，以及如何受到HF类型（HFPEF，HFREF）的影响，脆弱和姑息治疗和临终关怀服务（AIM 1）。接下来，我们将调查包括有关生命终结的患者提供对话（AIM 2）的频率提高护理计划的频率（AIM 2）。最后，我们将确定预先护理计划和患者偏好是否有助于医疗资源使用差异（包括住院）（AIM 3）。研究设计和成果指标：研究将在明尼苏达州奥尔姆斯特县进行。首先，在一群基于人群的HF患者中，他们在2003年至2012年对该提案的导师进行了研究中，我们将在死亡的人中的最后6个月中检查医疗保健资源利用（住院，门诊和急诊就诊）。使用Andersen-Gill模型来重复发生事件，将通过HF类型（HFPEF与HFREF）和脆弱的生命结束时住院的风险进行检查，并调整潜在的混杂因素。还将检查接受姑息医学咨询和临终关怀服务的人的医疗保健使用差异。其次，我们将前瞻性地招募连续的Olmsted县居民住院的HF，并使用面对面的调查表评估他们的生命偏好，并参与预先护理计划，并按照HF和脆弱的类型比较差异。最后，将遵循入学的患者，并使用安德森·吉尔（Andersen-Gill）模型确定生命偏好和医疗资源使用终结之间的关联。潜在的公共卫生贡献：缺乏有关高级HF生命终止偏好的数据及其与资源利用率的关联。拟议的目标将解决知识中的这些关键差距，从而告知我们可能会干扰共同决策过程的HF患者的潜在差异，如果改善，可能会导致住院治疗的降低，并改善了患者与NHLBI与DISMISS的患者满意度的关系：这些研究旨在确定与HF相处的方法，以使其与HF的生活变得更加完善，以使他们能够实现这一生活，从而使他们能够实现这一生活。与候选人的职业目标的关系：拟议的研究将为HF基于人群的卫生服务研究的表现提供必要的高级接触，并将成为候选人建立HF健康服务和成果研究职业的基础。