Continuity of care and end of the life ICU use

护理连续性和临终 ICU 使用

基本信息

批准号：
7662366
负责人：
Gulshan Sharma
金额：
$ 11.96万
依托单位：
UNIVERSITY OF TEXAS MED BR GALVESTON
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-01 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7662366
关键词：
Address Affect Age American Cancer Patient Caring Characteristics Comorbidity Competence Complement Continuity of Patient Care Critical Care Critical Illness Data Diagnosis Educational Background Elderly Environment Ethical Issues Face Fostering Gender Geographic Locations Goals Growth Health Services Health Services Research Hospitalists Hospitalization Hypersensitivity Immunology Inpatients Internal Medicine Intervention K-Series Research Career Programs Life Lung Malignant neoplasm of lung Marital Status Measures Medicine Mentors Mentorship Methods Modeling Outpatients Palliative Care Patients Physicians Principal Investigator Provider Race Research Research Activity Research Personnel Research Project Grants Resources Role Services Sleep Socioeconomic Status Teaching Hospitals Terminal Disease Terminally Ill Training Work career end of life end of life care experience hospice environment improved indexing insight medical specialties organizational structure patient oriented research professor rapid growth treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Candidate: Gulshan Sharma, MD, is an assistant professor in the Department of Internal Medicine, Division of Allergy, Pulmonary, Immunology, Critical Care and Sleep (APICS) Medicine who will serve as principal investigator on this project. His passion is to provide high quality end of life care to terminally ill older adults. Dr Sharma's long-term goal is to develop a career an an independent investigator in patient-oriented research. His immediate goals are 1) to study the impact of continuity of care on end of life ICU use in older adults with terminal illnesses, 2) to obtain additional training in conducting health services research with formal coursework, and 3) to particate in the care of critically ill patients. Environment: The mentorship and institutional resources available to Dr Sharma create an ideal environment for fostering his career in this underexamined but highly relevant field. Drs. Goodwin and Freeman brings considerable experience in both mentoring and health services research in older adults. Drs. Bruera and Brody complement the team with their expertise in end of life care and ethical issues when dealing with terminally ill hospitalized patients, respectively. The overarching aim of this study to examine the role of continuity of care on end of life ICU use. Research plan: The specific aims of the research are: Aim 1. To describe continuity of care in patients one year prior to the diagnosis of lung cancer. Aim 2. To describe patient and physician level characteristics associated with continuity of care in transition from outpatient to inpatient setting. Aim 3. To determine the relationship between continuity of care and end of life ICU use. Aim 4. To examine the effect of hospitalists on continuity of care and end of life ICU use. Methods: First, we will assess both the continuity score and usual care provider in the 12 months prior to diagnosis for advanced lung cancer patients. Second, we will assess transition care continuity by determining whether the outpatient physician provided care during hospitalization in the last 6 months of life. Third, we will examine the associations between continuity score/ usual care provider/ transition care continuity and end-of-life ICU use. Lastly, we will use the operational definition of hospitalist to examine the relationship between inpatient care by a hospitalist and end of life ICU use. Importance: Findings from the proposed study will provide important insight into how changing practices of medicine in last two decades have impacted ICU use in terminally ill patients. Interventions to improve continuity in terminally ill hospitalized patients can help reduce end of life ICU use.

描述（由申请人提供）：候选人：医学博士Gulshan Sharma是内科，过敏，肺部，免疫学，重症监护和睡眠（APICS）医学系的助理教授，他将担任该项目的首席研究员。他的热情是为绝症的老年人提供高质量的生命护理。 Sharma博士的长期目标是发展职业为以患者为导向的独立研究者。他的直接目标是1）研究护理连续性对患有绝症的老年人的生命终止ICU使用的影响，2）在接受正式课程的医疗服务研究中获得额外的培训，以及3）颗粒物在重症患者的护理中。环境：Sharma博士可用的指导和机构资源创造了一个理想的环境，以促进他在这个不足以但高度相关的领域中的职业生涯。博士。古德温（Goodwin）和弗里曼（Freeman）在老年人的指导和卫生服务研究方面具有丰富的经验。博士。布鲁拉（Bruera）和布罗迪（Brody）分别在与绝症住院患者打交道时，在生命终止和道德问题上的专业知识补充了他们的专业知识。这项研究的总体目的是研究护理连续性在ICU使用末期的作用。研究计划：研究的具体目的是：目的1。描述肺癌诊断前一年患者的护理连续性。目的2。描述与从门诊到住院环境的过渡过程中护理连续性相关的患者和医师水平的特征。目标3。确定护理连续性与生命终结ICU使用之间的关系。目标4。检查医院主义者对护理连续性和生命终结ICU使用的影响。方法：首先，我们将在诊断出晚期肺癌患者诊断前的12个月内评估连续性评分和常规护理提供者。其次，我们将通过确定门诊医师在生命的最后6个月内是否在住院期间提供护理来评估过渡护理的连续性。第三，我们将研究连续性得分/常规护理提供者/过渡护理连续性与临终ICU使用之间的关联。最后，我们将使用住院医生的操作定义来检查住院医生的住院护理与生命终结ICU使用之间的关系。重要性：拟议研究的发现将为过去二十年来不断变化的医学实践如何影响ICU在绝症患者中使用的重要见解。改善治疗患者的连续性的干预措施可以帮助减少ICU使用的寿命。