Beyond 30-Days: Patient-Oriented Outcomes Among Older Adults After Emergency General Surgery

30 天之后：急诊普通手术后老年人的以患者为中心的结果

• 批准号: 9927967
• 负责人: Zara R Cooper
• 金额: $ 11.08万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9927967
• 关键词: Accident and Emergency department; Acute; Acute myocardial infarction; Address; Admission activity; Advance Care Planning; Advance Directives; Age; Aging; Boston; Caring; Cessation of life; Characteristics; Cholecystitis; Clinical; Cognitive; Communication; Complication; Congestive Heart Failure; Data; Data Set; Death Rate; Elderly; Emergency Situation; Emergency department visit; Family; Funding; Future; Goals; Health; Health Services; Healthcare; Hospitalization; Hospitals; Individual; Inpatients; Intervention; Interview; Intestinal Obstruction; Intestinal Perforation; Knowledge; Length of Stay; Life; Life Experience; Measurement; Medical; Medicare claim; Methodology; Myocardial Infarction; Nursing Homes; Operative Surgical Procedures; Outcome; Palliative Care; Patient Care; Patient Recruitments; Patient-Focused Outcomes; Patients; Pneumonia; Population; Postoperative Complications; Postoperative Period; Procedures; Provider; Proxy; Quality of life; Recovery; Research; Research Personnel; Sampling; Small Intestines; Social support; Structure; Symptoms; Time; Work; care delivery; cohort; comorbidity; disability; end of life; end of life care; expectation; experience; functional decline; functional status; health care service utilization; health service use; high risk; hospice environment; hospital readmission; human old age (65+); improved; indexing; mortality; mortality risk; multiple data sources; older patient; operation; patient oriented; prospective; symptom management; trend

Project Summary/Abstract Emergency General Surgery (EGS) procedures are among the most morbid and common operations in older adults. Postoperative mortality risk in older EGS patients is 3 times higher than for older patients after elective surgery, and 2-7 times higher than for younger EGS patients. Moreover, up to half of older EGS patients experience postoperative complications and most are discharged to nursing homes. With demographic shifts, the rate of EGS in older adults is expected to increase. However, outcomes that are particularly relevant to older EGS patients such as survival beyond 30-days, functional and cognitive trajectories, quality of life, and palliative care needs are unknown. This proposal addresses these knowledge gaps utilizing multiple data sources and complementary methodologies. First, Medicare Claims will be used to examine 12-month survival and health care utilization in a national cohort. Second, primary prospective data will be collected from a cohort of older EGS patients and their proxies to examine key outcomes unavailable in secondary datasets including symptom burden, functional and cognitive status, quality of life, advance care planning, and quality of end-of- life care. Third, qualitative analyses of semi-structured interviews with patients and proxies will be done to obtain a richer understanding about their lived experience. The Specific Aims are: 1. To use National Medicare Claims to describe 12-month outcomes including survival, post-acute nursing home use, rehospitalization, and hospice use in older EGS patients (N=650,157), identify factors associated with better outcomes, and to compare these outcomes in a propensity-matched cohort of patients emergently hospitalized for three common medical conditions (pneumonia, congestive heart failure, and myocardial infarction, N=2,013,861); 2. To prospectively follow a cohort of older EGS patients (n~150) and their proxies (n~150) up to 12 months after surgery, to identify modifiable factors associated with fewer hospital transfers, better quality of life, and better end-of-life care; and, 3. To use a phenomenological approach to qualitatively analyze semi- structured interviews with patients (N=20) and proxies (N=20) from the cohort in Aim 2, to obtain an in-depth understanding of opportunities to improve post-surgical care in the following domains: quality of provider communication, advance care planning, symptom management, care transitions, and proxy experience. IMPACT: This work represents key steps in improving surgical care for older EGS patients by directly informing individual clinical decisions, setting expectations for recovery, helping to plan subsequent heath care needs, and revealing targets to improve surgical care delivery and palliative care for these patients. Finally, the work will establish the applicant as one of the few surgical health services researchers with expertise in aging and palliative care, and will prepare her to become an independent R01-funded investigator.

项目摘要/摘要 紧急通用手术（EGS）程序是较老的病态和常见操作之一 成年人。老年病人的术后死亡率风险是选修后老年患者的3倍 手术，比年轻的EGS患者高2​​-7倍。此外，多达一半的老年患者 经历术后并发症，大多数都被送往疗养院。随着人口变化的 老年人的EG率预计会增加。但是，与 年龄较大的EGS患者，例如30天以上的生存，功能和认知轨迹，生活质量以及 姑息治疗需求未知。该提案利用多个数据解决了这些知识差距 来源和补充方法。首先，Medicare索赔将用于检查12个月的生存 和国家队列中的医疗保健利用。其次，将从队列收集主要的前瞻性数据 在辅助数据集中不可用的关键结果，包括 症状负担，功能和认知状况，生活质量，预先护理计划以及质量 生命护理。第三，对患者和代理的半结构化访谈的定性分析将进行 对他们的生活经历获得更丰富的了解。具体目的是：1。使用国家 Medicare声称要描述12个月的成果，包括生存，急性后疗养院使用， 重新住院和临终关怀在老年EGS患者中（n = 650,157），确定与更好的因素 结果，并在倾向匹配的患者队列中比较这些结果 对于三种常见的医疗状况（肺炎，充血性心力衰竭和心肌梗塞， n = 2,013,861）; 2。前瞻性地跟随一组老年EGS患者（n〜150）及其代理（n〜150） 手术后12个月，要确定与更少的医院转移相关的可修改因素，质量更好 生活，更好的临终护理； 3。要使用一种现象学方法来定性分析半 AIM 2中对患者（n = 20）和代理（n = 20）的结构化访谈，以获得深入 了解在以下领域改善手术后护理的机会：提供者的质量 沟通，预先护理计划，症状管理，护理过渡和代理经验。 影响：这项工作代表了通过直接告知老年人患者改善外科手术护理的关键步骤 个人临床决策，设定恢复期望，有助于计划随后的健康护理需求， 并揭示了为这些患者改善手术护理分娩和姑息治疗的靶标。最后，工作 将建立申请人为少数具有衰老专业知识的外科健康服务研究人员之一 姑息治疗，并将为她做好准备，成为一名独立的R01资助的调查员。

项目成果

Care Discontinuity in Emergency General Surgery: Does Hospital Quality Matter?

• DOI: 10.1016/j.jamcollsurg.2020.02.025
• 发表时间: 2020-06-01
• 期刊: JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
• 影响因子: 5.2
• 作者: Havens, Joaquim M.;Castillo-Angeles, Manuel;Cooper, Zara
• 通讯作者: Cooper, Zara

Older adults' perspectives 3 months after emergency general surgery highlight opportunities to improve care.

• DOI: 10.1111/jgs.17152
• 发表时间: 2021-07
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Sokas C;Yeh IM;Bernacki RE;Rangel EL;Kaafarani H;Mitchell SL;Bader AM;Ladin K;Palmer JA;Tulsky JA;Cooper Z
• 通讯作者: Cooper Z

Ethical considerations about emergent surgical hospitalizations in patients with advanced cancer.

晚期癌症患者紧急手术住院的伦理考虑。

• DOI: 10.1002/cncr.31684
• 发表时间: 2018
• 期刊: Cancer
• 影响因子: 6.2
• 作者: Lee,KatherineC;Cooper,Zara
• 通讯作者: Cooper,Zara

Quality Indicators in Surgical Palliative Care: A Systematic Review.

外科姑息治疗的质量指标：系统评价。

• DOI: 10.1016/j.jpainsymman.2021.01.122
• 发表时间: 2021
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Lee,KatherineC;Sokas,ClaireM;Streid,Jocelyn;Senglaub,StevenS;Coogan,Kathleen;Walling,AnneM;Cooper,Zara
• 通讯作者: Cooper,Zara

Perioperative Symptoms: A New Frontier for Surgical Palliative Care.

围手术期症状：外科姑息治疗的新领域。

• DOI: 10.1097/sla.0000000000004698
• 发表时间: 2021
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Lilley,ElizabethJ;Baig,HumaS;Cooper,Zara
• 通讯作者: Cooper,Zara