Determinants of Critical Care Intensity for Hospitalized Older Adults: the Effect of Hospital-based Palliative Care Services

住院老年人重症监护强度的决定因素：医院姑息治疗服务的效果

• 批准号: 8966057
• 负责人: May Hua
• 金额: $ 17.77万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8966057
• 关键词: Academic Medical Centers; Accounting; Admission activity; Adult; Advocate; Affect; American Hospital Association; Caring; Cessation of life; Characteristics; Consultations; Critical Care; Critical Illness; Data; Data Element; Data Set; Data Sources; Development; Distress; Dose; Elderly; Ensure; Etiology; Family; Foundations; Future; Goals; Health Services Research; Hospitals; Intensive Care; Intensive Care Units; Interview; Length; Measures; Methods; Modeling; New York; Outcome; Outcomes Research; Palliative Care; Patient Preferences; Patients; Penetration; Perceived quality of life; Policies; Population; Provider; Qualitative Methods; Quality of Care; Registries; Research; Research Personnel; Resources; Risk; Sampling; Services; Structure; Surveys; Survivors; Testing; Translating; Validation; Validity and Reliability; Work; aging population; base; career; clinical care; cohort; end of life; evidence base; high risk; implementation research; improved; life-sustaining therapy; meetings; palliative; preference; programs; public health relevance; research study; response; validation studies

 DESCRIPTION (provided by applicant): The goal of the proposed studies and educational plan is to develop the PI into an independent investigator with the career goal of improving geriatric critical care through evidence-based delivery of palliative and end-of- life care for oldr adults in the intensive care unit (ICU). Older adults who are critically ill often undergo high- intensity care while simultaneously being at high-risk of death. This high-intensity treatment may result in significant discomfort and may not improve survival or be in-line with patients' preferences. The use of palliative care has been advocated as a strategy for realigning the intensity of care that is delivered with the intensity of care that is desired by patients and families. We have already demonstrated that among older adults, the need for palliative care consultation is common during high intensity treatment. In single-center studies, the use of palliative care in the ICU has been associated with markers of lower treatment intensity. However, with the recent expansion of palliative care programs, it is unclear if palliative care services have similar outcomes on a larger scale. Consequently, we plan to examine whether the availability of hospital- based palliative care services affects critical care outcomes for oldr adults by analyzing a merged multi-center data source created for this project. We will test the hypothesis that the presence of hospital-based palliative care services is associated with lower treatment intensity for critically ill older adults with three aims: 1) validate methods to study hospital-based palliative care services using administrative and proprietary data 2) determine if the availability of hospital-based palliative care services is associated with lower treatment intensity and 3) identify ICU and provider characteristics associated with high-penetration of palliative care within the ICU. We will accomplish these aims with quantitative methods, through analysis of a uniquely merged dataset of statewide hospital discharge data from New York State, data from the Annual American Hospital Association Survey and data from the National Palliative Care Registry, and with qualitative methods, using semi- structured interviews. This dataset will contain detailed information about patients and clinical care, hospital characteristic and operating characteristics of palliative care programs.

 描述（由申请人提供）：拟议研究和教育计划的目标是将 PI 发展成为一名独立研究者，其职业目标是通过为老年人提供基于证据的姑息治疗和临终关怀来改善老年重症护理重症监护病房 (ICU) 中的老年人经常接受高强度护理，同时面临高死亡风险。符合姑息治疗已被提倡作为一种根据患者和家庭所需的护理强度重新调整护理强度的策略。我们已经证明，在老年人中，姑息治疗的必要性。在高强度治疗期间进行护理咨询很常见，在 ICU 中使用姑息治疗与较低治疗强度的标志相关，但是，随着最近姑息治疗计划的扩大，目前尚不清楚姑息治疗是否有效。服务有类似的结果在更大规模的研究中，我们计划通过分析为本项目创建的合并多中心数据源来检验医院姑息治疗服务的可用性是否会影响老年人的重症护理结果。医院姑息治疗服务的增加与危重老年人的较低治疗强度相关，其三个目的是：1) 使用管理和专有数据验证研究医院姑息治疗服务的方法 2) 确定医院姑息治疗的可用性护理服务与较低的治疗强度，3) 确定与 ICU 内姑息治疗高渗透率相关的 ICU 和提供者特征，我们将通过分析来自纽约州的被告出院数据的独特合并数据集，定量地实现这些目标。该数据集将包含有关患者和临床护理、医院特征和姑息治疗项目运营特征的详细信息。