Towards Understanding the Patient Experience of Overuse of Medical Resources

了解过度使用医疗资源的患者体验

• 批准号: 9305822
• 负责人: JODI B. SEGAL
• 金额: $ 15.95万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9305822
• 关键词: Address; Aging; American; Award; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Data Sources; Decision Making; Developed Countries; Developing Countries; Development; Disease; Elderly; Ethical Issues; Expenditure; Failure; Family; Focus Groups; Harm Reduction; Health; Health Expenditures; Healthcare; Healthcare Systems; Heterogeneity; Individual; Intervention; Justice; K-Series Research Career Programs; Medical; Medicine; Mentors; Methodology; Methods; Mid-Career Clinical Scientist Award (K24); Morbidity - disease rate; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Polypharmacy; Provider; Qualitative Research; Quality of Care; Quality of life; Research; Research Methodology; Research Personnel; Research Support; Research Training; Resources; Review Literature; Risk; Services; Specialist; Syndrome; System; Talents; Testing; United States; Work; adverse outcome; care delivery; career; cohort; cost; disorder prevention; end of life; experience; frailty; health care service; improved; indexing; interest; multiple chronic conditions; news; next generation; older patient; patient oriented; preference; public health relevance; screening; skills; systematic review

 DESCRIPTION (provided by applicant): Health outcomes in the United States lag behind other developed nations despite health expenditures that are exceptionally high and growing. This disparity has led many to conclude that healthcare services are overused, a phenomenon driven by a perfect storm of patient, provider, and institutional determinants. Overuse has been defined as the provision of care in circumstances where the potential for harm exceeds the potential for benefit. While overuse is pervasive throughout the healthcare system, older Americans may be particularly at risk for receipt of services where the potential for harm exceeds the potential for benefit. This may include the use of screening tests when there are conditions causing substantial competing risks for death, therapies delivered at end-of-life that do not impact disease course or quality of life, therapies delivered without recognition of the heterogeneity among older patients due to frailty, polypharmacy in multimorbid patients, and care coordination failure when multiple specialists are involved in care. Overuse of healthcare puts patients at risks of adverse outcomes and has system-wide consequences, and yet this is poorly appreciated by patients, their families, and their clinicians. I seek this K24 award to support my effort as a researcher and mentor of talented young investigators as we work to understand overuse of healthcare and advance the practice of "parsimonious medicine", a term reflecting the prudent delivery of care necessary for the patient's good. The overarching aim of this career development award is to work towards harm reduction for older patients through parsimonious healthcare use, and concurrently, advance my skills in patient centered outcomes research and train the next generation of researchers in this field. With my mentees, mentors, and colleagues, I will: a) systematically review the literature about determinants of overuse of healthcare resources; b) conduct a qualitative study via focus groups to understand how patients perceive overuse and its harms; c) use stated-preference methods to understand how older patients make decisions about their use of healthcare and how this varies in the presence of geriatric syndromes, and d) validate the Johns Hopkins Index of Overuse with additional data sources and explore the impact of Accountable Care Organization establishment on overuse of resources in older patients. The impact of this award is expected to be the completion of important research to inform the care of older adults, the advancement of a cohort of young investigators with skills to address these topics and others relevant to improved care delivery, and the personal advancement of my skills so that I can be an ever more effective researcher and mentor.

 描述（由适用提供）：美国的健康成果落后于其他发达国家目的地的健康支出，这些支出异常高且增长。这种差异使许多人包括医疗服务被过度使用，这是由患者，提供者和机构决定者的完美风暴驱动的现象。过度使用已被定义为在造成伤害潜力超过利益潜力的情况下提供的护理。尽管过度使用在整个医疗保健系统中都普遍存在，但老年人可能特别面临接收危害可能超过利益潜力的服务的风险。这可能包括使用筛查测试在存在条件时会导致死亡的实质性竞争风险，在寿命末提供的疗法，不会影响疾病课程或生活质量，而在不认识年龄较大的患者的疗法中，由于多发性病人的多疗法以及多次护理失败涉及多个专家的疗法，在多个专家中涉及多个患者。过度使用医疗保健会使患者面临不良结果的风险，并且会带来范围内的后果，但是患者，家人及其临床医生对此表示不好的赞赏。我寻求这个K24奖，以支持我作为才华横溢的年轻调查人员的研究人员和导师的努力，因为我们努力了解过度使用医疗保健并推动“简约医学”的实践，这一术语反映了对患者益处所必需的谨慎提供护理的术语。该职业发展奖的总体目的是通过帕尔西姆医疗保健使用努力减少老年患者的伤害，并同时提高我在以患者为中心的结果研究中的技能，并培训该领域的下一代研究人员。借助我的月经，导师和同事，我将：a）系统地回顾有关确定医疗资源过度使用的文献； b）通过焦点小组进行定性研究，以了解患者对过度使用及其危害的看法； c）使用既定选择方法了解老年患者如何决定他们对医疗保健的使用，以及在存在老年综合症的存在下如何做出这种多样性，d）验证约翰·霍普金斯（Johns Hopkins）用其他数据源过度使用的约翰·霍普金斯指数，并探索责任护理组织对老年患者资源过度使用的影响。预计该奖项的影响将是完成重要研究的完成，以告知老年人的护理，促进一群具有解决这些主题的年轻调查员的促进，这些研究人员可以解决这些主题，并且与改善的护理交付有关，以及对我的技能的个人进步，以便我可以成为更有效的研究人员和导师。