An ICU Intervention to Improve End-of-Life Care

改善临终关怀的 ICU 干预措施

• 批准号: 7032462
• 负责人: J Randall Curtis
• 金额: $ 58.08万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7032462
• 关键词: clinical research; clinical trials; decision making; health care personnel education; health care service evaluation; health services research tag; hospital analysis; intensive care; medical records; nurse patient relations; nurses; nursing care quality; nursing research; patient oriented research; physicians; questionnaires; respiratory therapy; satisfaction; terminal patient care

DESCRIPTION (provided by applicant): A large portion of deaths in the U.S. occurs in the intensive care unit (ICU) or after a stay in the ICU. There is mounting evidence of problems in the quality of care these patients and their families receive, although much of this evidence comes from academic medical centers. This proposal is a competitive renewal of our previous 2-year R01 that examined the quality of clinician-family communication about end-of-life care in the ICU. In the prior grant, we identified specific shortcomings in patient-clinician communication and discovered that an intervention to improve this communication cannot exclusively target the ICU family conference. Based on the findings of the prior grant, this competitive renewal application proposes to evaluate an organizational, nurse-focused intervention to improve end-of-life care in the ICU with 5 components: 1) nurse, physician, and respiratory therapist education regarding the principles and practice of palliative care in the ICU; 2) academic detailing nurse, physician, and respiratory therapist directors identifying and addressing local barriers to quality end-of-life care; 3) implementation of standardized "withdrawal of life support" order forms and family pamphlets; 4) guidance from local nurse, physician, and respiratory therapist champions; and 5) feedback of local quality improvement data in comparison to the aggregated ratings at the other sites. The intervention will be evaluated in a randomized, controlled trial with the hospital as the unit of randomization and the hospital and the ICUs as the target of the intervention. The outcomes include: a) the previously validated "Quality of Dying and Death" questionnaires assessed by families and nurses, b) satisfaction with care assessed by the families and nurses, and c) indicators of quality of care assessed by nurses and from medical record review. The primary outcome is family-assessed "Quality of Dying and Death". Statistical analyses use generalized estimating equations to allow analysis of patient-level data while controlling for the clustering within units and hospitals. The goal of this proposal is to demonstrate the effectiveness of a generalizable, multi-faceted, nurse-focused quality improvement project designed to improve end-of-life care in the ICU.

描述（由申请人提供）：美国大部分死亡发生在重症监护室（ICU）或在ICU住宿之后。 这些患者及其家人收到的护理质量有问题，尽管这些证据大部分来自学术医疗中心。 该提案是对我们上前两年R01的竞争性更新，该提案研究了有关ICU中有关临终关怀医疗服务的临床医生 - 家庭沟通质量。 在先前的赠款中，我们确定了患者临床沟通中的具体缺点，发现改善这种交流的干预措施不能仅针对ICU家庭会议。 根据先前赠款的发现，这种竞争性更新应用程序建议评估组织，注重护士的干预措施，以改善ICU中有5个组成部分的ICU中的生命终止护理：1）ICU中有关Palliative Care的原理和实践的护士，医师和呼吸治疗师教育； 2）学术细节护士，医师和呼吸治疗师董事确定并解决了当地质量终止护理的障碍； 3）实施标准化的“撤回生命支持”命令和家庭小册子； 4）当地护士，医师和呼吸治疗师冠军的指导； 5）与其他站点的总评级相比，本地质量改进数据的反馈。 干预措施将在医院的随机对照试验中评估为随机分配，医院和ICU作为干预措施的目标。 结果包括：a）由家庭和护士评估的先前验证的“垂死和死亡质量”问卷，b）对家庭和护士评估的护理满意，c）护士评估的护理质量指标和病历审查。 主要结果是对家庭评论的“垂死和死亡的质量”。 统计分析使用通用估计方程式来分析患者级别的数据，同时控制单位和医院内的聚类。 该提案的目的是证明旨在改善ICU中寿命终止护理的可推广，多方面的，以护士为中心的质量改进项目的有效性。