CHANGE OF GRANTEE INSTITUTION K23 HL146890 A Systems Approach to Align ICU Care with Patient Treatment Goals

受资助机构变更 K23 HL146890 使 ICU 护理与患者治疗目标保持一致的系统方法

基本信息

批准号：
10324027
负责人：
Jacqueline Marie Kruser
金额：
$ 16.78万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10324027
关键词：
Acute Address Adult Award Behavior Behavior Therapy Bypass Caring Cessation of life Chronic Clinical Clinical Trials Collaborations Communication Communication Tools Complex Conduct Clinical Trials Critical Care Critical Illness Decision Making Dependence Development Plans Elderly Engineering Environment Extramural Activities Face Failure Family Family Physicians Foundations Funding Future Goals Healthcare Incidence Individual Intensive Care Units Intervention K-Series Research Career Programs Knowledge Lead Learning Life Lung Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Modeling Multicenter Trials Operative Surgical Procedures Organ failure Outcomes Research Outcomes and Health Services Research Patient Care Patient Preferences Patients Physicians Prevalence Procedures Process Property Quality of life Reporting Research Research Infrastructure Research Personnel Resources Risk Schools Series Site Structure Study models Surgeon Syndrome System Testing Training United States Universities Work acceptability and feasibility career career development clinical practice design end of life end of life care end-of-life decision making engineering design experience feasibility testing functional independence health care delivery improved interest medical schools novel novel strategies older patient patient oriented patient population preference programs shared decision making simulation skills social therapy design therapy development tool user centered design

项目摘要

ABSTRACT The support of this career development award will help Jacqueline M Kruser, MD MS become an independent physician-investigator with the training and experience necessary to improve communication and treatment decision making for patients with critical illness. Dr. Kruser will use this award to build on her existing foundation in health services and outcomes research to achieve two career development goals: (1) Develop expertise in the application of systems engineering principles and methods in healthcare, and (2) Gain knowledge and experience in the conduct of clinical trials of complex behavioral interventions. These skills will expand Dr. Kruser's research focus beyond individual-level interventions to address the complex, system-level factors that influence treatment decision making and end-of-life care for patients with life-threatening illness, specifically in chronic critical illness. Dr. Kruser will achieve these career objectives through a 5-year career development plan that involves structured didactics, patient-oriented experiential research, and intensive mentoring. Dr. Kruser's career development will be mentored by Jane L Holl MD MPH, a physician with experience in applying systems engineering methods in healthcare, with over 20 years of sustained extramural funding, and an outstanding record of mentorship. The co-mentors of this award are experts in clinical trials and outcomes research in critical care (Richard G Wunderink, MD), and end-of-life decision making and behavioral intervention development (Margaret Schwarze, MD MPP). Dr. Kruser's career development will be supported by the exceptional institutional environment of Northwestern University, including the (1) Dedicated resources from the Division of Pulmonary and Critical Care Medicine and Department of Medicine, (2) Strong research infrastructure of the interprofessional Center for Healthcare Studies (directed by Dr. Holl), and (3) Established, productive collaborations between the McCormick School of Engineering and the Feinberg School of Medicine. Nearly 400,000 people in the US develop chronic critical illness each year, and most older adults with this condition will not survive beyond one year. Studies suggest that many older adults with chronic critical illness who are near the end of life receive unwanted care that does not reflect their goals, values, or preferences, referred to as “goal-discordant” care. Thus, the overall research objective of this award is to apply the tools of systems engineering to adapt an existing individual-level communication tool, “Best Case/Worst Case,” to reduce goal-discordant care in older adults at risk for chronic critical illness. Specific Aim 1 will identify the most impactful ICU system failures in communication and treatment decision-making through a Failure Mode, Effects, and Criticality Analysis. Next, Specific Aim 2 will use user-centered design engineering and simulation testing to adapt “Best Case/Worst Case” to the complex ICU system. Finally, Specific Aim 3 will test the feasibility and acceptability of the novel intervention through a two-site, pilot clinical trial.

抽象的该职业发展奖的支持将帮助Jacqueline M Kruser，医学博士成为独立医师评估者通过改善沟通和治疗所需的培训和经验重病患者的决策。 Kruser博士将使用该奖项来建立她的现有卫生服务和成果研究基础，以实现两个职业发展目标：（1）发展在医疗保健中应用系统设计原理和方法方面的专业知识，以及（2）增益在进行复杂行为干预的临床试验中的知识和经验。这些技能会将克鲁瑟博士的研究重点扩展到个人级别的干预措施之外，以解决复杂的系统级别影响治疗决策和临终关系护理的因素，以威胁生命的疾病患者克鲁瑟博士将在5年的职业生涯中实现这些职业目标涉及结构化教学，以患者为导向的专家研究和密集的开发计划指导。 Kruser博士的职业发展将由Jane L Holl MD MPH指导，在医疗保健中应用系统工程方法的经验，拥有20多年的持续壁外资金和出色的心态记录。该奖项的联合官员是临床试验的专家以及重症监护的结果（理查德·W·温德克（Richard G Wunderink），马里兰州），以及临终关怀的决策和行为干预发展（Margaret Schwarze，MD MPP）。克鲁瑟博士的职业发展将是得到西北大学特殊机构环境的支持，包括（1）专用肺和重症监护医学和医学系的资源，（2）跨专业医疗研究中心（由Holl博士指导）的研究基础设施和（3）麦考密克工程学院与费恩伯格学校之间建立的产品合作每年在美国发展近40万人，大多数老年人在这种情况下，将无法生存一年。研究表明，许多患有慢性关键的老年人生命尽头的疾病得到了不需要的护理，这些护理无法反映其目标，价值观或偏好，称为“目标遗嘱”护理。这是该奖项的总体研究目标是应用系统工程的工具可以调整现有的个人级通信工具，“最佳情况/最坏案例，“减少患有慢性重症疾病风险的老年人的目标治疗。特定的目标1将通过A确定最具影响力的ICU系统失败故障模式，效果和批判性分析。接下来，特定的目标2将使用以用户为中心的设计工程和模拟测试以使“最佳情况/最坏情况”适应复杂的ICU系统。最后，特定的目标3将通过一项两个站点的试验临床试验来测试新干预的可行性和可接受性。