A Systems Approach to Align ICU Care with Patient Treatment Goals

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：
9918968
负责人：
Jacqueline Marie Kruser
金额：
$ 16.81万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-01 至 2020-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9918968
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 career career development clinical practice design end of life end of life care end-of-life decision making engineering design experience 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, MD MS 成为一名独立的具有改善沟通和治疗所需的培训和经验的医师研究员 Kruser 博士将利用该奖项为危重患者做出决策卫生服务和成果研究的基础，以实现两个职业发展目标：(1) 发展在医疗保健领域应用系统工程原理和方法的专业知识，以及（2）获得进行复杂行为干预临床试验的知识和经验。将 Kruser 博士的研究重点扩展到个人层面的干预措施之外，以解决复杂的系统层面的问题影响危及生命疾病患者的治疗决策和临终关怀的因素， Kruser 博士将通过 5 年的职业生涯实现这些职业目标。发展计划，涉及结构化教学、以患者为导向的体验研究和强化 Kruser 博士的职业发展将由医学博士、公共卫生硕士 Jane L Holl 进行指导。在医疗保健领域应用系统工程方法的经验，拥有 20 多年持续的校外经验该奖项的共同导师是临床试验领域的专家。重症监护领域的结果研究（Richard G Wunderink，医学博士）以及临终决策和行为干预发展（Margaret Schwarze，MD MPP）Kruser 博士的职业发展将是。得到西北大学卓越的制度环境的支持，包括（1）来自肺科和重症医学科和医学部的资源，（2）强跨专业医疗保健研究中心的研究基础设施（由霍尔博士指导），以及（3）麦考密克工程学院和范伯格学院之间建立了富有成效的合作美国每年有近 400,000 人患有慢性危重疾病，其中大多数是老年人。研究表明，许多患有慢性危重病的老年人将无法存活超过一年。临近生命尽头的疾病患者接受了不必要的护理，而这些护理并不反映他们的目标、价值观或因此，该奖项的总体研究目标是应用。系统工程工具，以适应现有的个人级沟通工具，“最好情况/最坏情况” Case”，以减少对患有慢性危重疾病风险的老年人的目标不一致的护理，具体目标 1 将。通过以下方式确定沟通和治疗决策中影响最大的 ICU 系统故障：接下来，特定目标 2 将使用以用户为中心的设计工程。以及模拟测试，以适应复杂的 ICU 系统的“最佳情况/最坏情况”。最后，具体目标 3 将。通过两地试点临床试验来测试新型干预措施的可行性和可接受性。