Characterizing the Impact of Fragmented Care in Acute Respiratory Failure

描述分散护理对急性呼吸衰竭的影响

基本信息

批准号：
10665671
负责人：
Andrew John Admon
金额：
$ 16.96万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-15 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10665671
关键词：
Acute respiratory failure Address Adult Affect Ambulatory Care Award Awareness Caring Cessation of life Characteristics Clams Clinical Clinical Data Clinical Investigator Communication Complex Critical Care Data Data Sources Development Development Plans Doctor of Philosophy Ensure Epidemiology Event Excess Mortality Exposure to Foundations Global Change Goals Health Care Research Healthcare Systems Hospitalization Hospitals Inpatients Intensive Care Units Length of Stay Link Lung Manuscripts Measures Medicine Mentors Methods Michigan Modernization National Heart, Lung, and Blood Institute National Research Service Awards Nosocomial Infections Observational Study Outcome Outpatients Patients Pharmaceutical Preparations Physicians Public Health Publications Research Research Methodology Research Personnel Respiratory Failure Safety Series Survey Methodology Surveys Techniques Testing Training United States Universities Veterans Health Administration Work care delivery care fragmentation career career development clinical effect design evidence base experience improved innovation inpatient service instrument lecturer novel prevent skills thrombotic complications

项目摘要

PROJECT SUMMARY/ABSTRACT Candidate’s Long-Term Career Goal: To become an independent investigator who uses advanced observational research methods to improve the organization and delivery of critical care. Clinical Problem to be Addressed: Acute respiratory failure leads to 2,000,000 hospitalizations and 400,000 deaths in the US each year. Outcomes vary widely across hospitals, suggesting that improvements to how care is organized and delivered may improve survival. Yet, global changes affecting inpatient care teams have encouraged fragmentation—discontinuous care spread across multiple physicians. Little is known about how fragmented care affects adults with respiratory failure and what hospitals can do to protect patients from harm. Specific Aims: Using advanced methods for causal inference applied to novel data sources, Dr. Admon will 1) compare the causal effects of fragmented care on in-hospital and post-hospital respiratory failure outcomes; 2) determine whether specific complications occur more often in fragmented care and predict poorer outcomes; and 3) test whether specific features of inpatient care are protective against harm when care is fragmented. Candidate’s Background: Dr. Andrew Admon is a Lecturer and Research Fellow in Pulmonary and Critical Care Medicine at the University of Michigan. He has advanced training in public health and health care research. He has 25 total publications, including 17 original research manuscripts, with 7 original research manuscripts as first author. Dr. Admon’s work is supported by an NHLBI NRSA F32 award. Career Development Plan: To meet his long-term career goal, Dr. Admon seeks deep, focused training in causal inference and survey methodology. Accordingly, his 5-year plan includes curated courses that build on his strong foundation in quantitative research, project-based mentoring by experts in critical care epidemiology, causal inference, and survey research, selected career development activities, and specific milestones to ensure a successful transition to independence. Dr. Admon’s primary mentor is Colin Cooke, MD, MS, MSc. His co-mentors are Andrew Ryan, PhD, Sarah Krein, PhD, RN, and Theodore J. Iwashyna, MD, PhD. Deliverables: Completing the research and training in this proposal will generate data informing strategies to mitigate fragmentation while equipping Dr. Admon with advanced skills in observational causal inference and survey methods. In subsequent work, this expertise will prepare him to maximally leverage observational data to generate timely and accurate evidence addressing other research challenges in critical care delivery.

项目概要/摘要候选人的长期职业目标：成为一名使用先进技术的独立调查员改善重症监护的组织和提供的观察研究方法。亟待解决的临床问题：急性呼吸衰竭导致200万人住院、40万人死亡美国每年的死亡结果在不同医院之间差异很大，这表明我们需要改进方法。组织和提供护理可能会提高患者的生存率，但影响住院护理团队的全球变化已经发生。鼓励分散化——不连续的护理分散在多个医生身上，但我们对如何做到这一点知之甚少。分散的护理会影响患有呼吸衰竭的成年人，以及医院可以采取哪些措施来保护患者免受伤害。具体目标：使用先进的因果推理方法应用于新颖的数据源，Admon 博士将 1) 比较分散护理对院内和院后呼吸衰竭结果的因果影响 2) 确定在分散的护理中是否更频繁地发生特定并发症并预测较差的结果； 3）测试住院护理的具体特征是否能够在护理分散时防止伤害。候选人背景：Andrew Admon 博士是肺科和重症科的讲师和研究员他在密歇根大学护理医学专业接受过公共卫生和医疗保健方面的高级培训。共发表论文25篇，其中原创研究手稿17篇，原创研究7篇。 Admon 博士作为第一作者的手稿得到了 NHLBI NRSA F32 奖的支持。职业发展计划：为了实现他的长期职业目标，阿德蒙博士寻求深入、有针对性的培训因此，他的五年计划包括基于因果推理和调查方法的策划课程。他在定量研究方面拥有坚实的基础，由重症监护流行病学专家进行基于项目的指导，因果推理、调查研究、选定的职业发展活动以及具体的里程碑确保 Admon 博士成功过渡到独立。他的共同导师是 Andrew Ryan 博士、Sarah Krein 博士、注册护士和 Theodore J. Iwashyna 医学博士、博士。可交付成果：完成本提案中的研究和培训将生成数据通知策略减轻碎片化，同时为 Admon 博士提供观察因果推理和在随后的工作中，这种专业知识将使他能够最大限度地利用观察数据。生成及时、准确的证据，解决重症监护服务中的其他研究挑战。

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

External Validation and Comparison of a General Ward Deterioration Index Between Diversely Different Health Systems.

不同卫生系统之间一般病房恶化指数的外部验证和比较。

DOI：
发表时间：
2023-06-01
期刊：
影响因子：
8.8
作者：
Cummings, Brandon C;Blackmer, Joseph M;Motyka, Jonathan R;Farzaneh, Negar;Cao, Loc;Bisco, Erin L;Glassbrook, James D;Roebuck, Michael D;Gillies, Christopher E;Admon, Andrew J;Medlin Jr, Richard P;Singh, Karandeep;Sjoding, Michael W;Ward, Kevi
通讯作者：
Ward, Kevi

Knowledge from the Noise: A Regression Discontinuity Design to Inform Optimal Transfusion Thresholds for Critically Ill Patients.

从噪声中获取知识：断点回归设计为危重患者提供最佳输血阈值。