Older Adult Safety in Surgery (OASIS II)

老年人手术安全 (OASIS II)

• 批准号: 8638620
• 负责人: Alok Kapoor
• 金额: $ 8.38万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8638620
• 关键词: Accounting; Aging; American College of Surgeons; Award; Boston; Caring; Clinic; Computers; Consultations; Data; Disease; Elderly; Equipment and supply inventories; Head; Institutes; Institution; Measurement; Measures; Medical; Medical center; Methods; National Institute on Aging; New England; Nursing Homes; Operative Surgical Procedures; Outcome; Patient Self-Report; Patients; Performance; Physical Function; Postoperative Period; Procedures; Process; Relative (related person); Reporting; Research; Research Personnel; Research Project Grants; Respondent; Risk; Role; Safety; Severity of illness; Stratification; Symptoms; Testing; Time; Universities; Visit; burden of illness; disability; exhaustion; experience; frailty; functional status; improved; indexing; instrument; medical complication; point of care; programs; public health relevance; response; safety net; self-reported functional status; tool

DESCRIPTION (provided by applicant): We seek the Institute on Aging Small Research Grant Program Award. The proposal, entitled "Older Adult Safety in Surgery (OASIS) II", focuses on the role of self-reported physical functional status compared with Fried Frailty Criteria for the purpose of preoperative risk stratification in older adults undergoing major surgery. Current methods for identifying which patients will have an adverse postoperative course - i.e. the process of risk stratification - rely on inventories of comorbid disease that do ot account for disease severity or burden. In addition, these methods focus on discrete medical complications and not on major complications as a whole, discharge to nursing home, or readmission, which are the outcomes most important to patients and policymakers. Recently, multiple aging investigators have attempted to develop improved assessment methods for identifying older adults at risk for adverse postoperative course. They have shown an association between frailty and increased need for discharge to nursing home after surgery. Given the need to make point of care physical performance measurements and record time intensive inventories of exhaustion symptoms and activity items, frailty remains a suboptimal method for risk stratifying older adult surgical patients. Assessing self-reported functional stats offers the ability to efficiently capture a wide range of vulnerability to an adverse postoperative course. Investigators at Boston University with the support of the National Institute on Aging (NIA) have developed a tool for assessing physical function, the Late Life Function (LL-F) part of the Late Life Function and Disability Instrument which may be applied in the preoperative setting. From a large bank of potential items, a computer adaptive testing version of this instrument uses a patient's initial responses to guide subsequent inquiry (e.g. omitting questions of lower function for someone who's already reported high function). In this proposal, I will prospectively collect Fried Frailty Criteria and LL-F from patients visiting the Pre-procedure Clinic at Boston Medical Center. To track outcomes, I will leverage data already being collected by the Department of Surgery as part of a quality initiative sponsored by the American College of Surgeons National Surgical Quality Improvement Program. Comparing LL-F via computer adaptive testing with frailty head-to-head can clarify the path we should take regarding preoperative risk stratification. This proposal captures the unique experiences of the PI who has been leading medical consultation at the largest safety net institution in New England. It also includes the expertise of multiple leaders in aging research.

描述（由申请人提供）：我们寻求老化小型研究赠款计划奖研究所。该提案名为“老年人在手术中（OASIS）II”，重点是自我报告的身体功能状况与炸脆弱标准相比，其目的是在接受大手术的老年人的术前风险分层。当前的方法用于确定哪些患者将患有术后不良病程 - 即风险分层的过程 - 依赖于造成疾病严重程度或负担的合并症的清单。此外，这些方法侧重于离散的医疗并发症，而不是整体上的重大并发症，疗养院或再入院，这对患者和决策者来说是最重要的结果。 最近，多个老龄化的研究人员试图开发改进的评估方法，以识别有不良术后病程的老年人。他们显示了脆弱的与手术后养老院出院需求增加之间的关联。鉴于需要进行护理点的身体性能测量，并记录疲劳症状和活动项目的时间密集型清单，因此脆弱的方法仍然是风险分层老年人外科手术患者的次优方法。 评估自我报告的功能统计数据提供了有效捕获术后不良脆弱性的能力 课程。波士顿大学的调查人员在国家老化研究所（NIA）的支持下开发了一种评估身体机能的工具，可用于术前的生命功能和残疾工具的晚期生命功能（LLL-F）部分环境。从一大批潜在项目中，该仪器的计算机自适应测试版本使用患者的初始答复来指导后续查询（例如，省略已经报告了很高功能的人的功能较低的问题）。 在此提案中，我将从前来访问波士顿医疗中心前诊所诊所的患者那里收集油炸脆弱的标准和LL-F。为了跟踪结果，我将利用手术部已经收集的数据，这是美国外科医生国家国家外科手术质量改进计划赞助的质量计划的一部分。通过计算机自适应测试与脆弱的头对头进行比较，可以阐明我们在术前风险分层方面应采取的道路。该提案捕捉了PI的独特经历，他们一直在新英格兰最大的安全网机构领导医疗咨询。它还包括衰老研究中多个领导者的专业知识。