Understanding Inappropriate Treatment in Critically Ill Older Patients

了解老年危重患者的不当治疗

• 批准号: 9222687
• 负责人: THANH H NEVILLE
• 金额: $ 16.85万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9222687
• 关键词: Age; Aging; Behavior; Biometry; Caring; Cessation of life; Clinical; Clinical Research; Communication; Comorbidity; Complement; Complex; Critical Care; Critical Illness; Data; Decision Making; Distress; Elderly; Ethics; Faculty; Family; Futile Treatments; Future; General Population; Geriatrics; Goals; Gray unit of radiation dose; Health Services; Healthcare; Institution; Intensive Care Units; Intervention; Judgment; Lead; Life; Lung; Medical; Medical Records; Medicine; Mentors; Methods; Modeling; Palliative Care; Patient-Focused Outcomes; Patients; Physicians; Process; Public Health; Qualitative Methods; Research; Research Personnel; Resources; Risk; Statistical Models; System; Technology; Work; base; burden of illness; career; experience; implementation science; improved; member; mortality; multi-component intervention; multidisciplinary; older patient; outcome forecast; patient subsets; preference; prospective; public health relevance; research and development; successful intervention; therapy development; tool

 DESCRIPTION (provided by applicant): Dr. Thanh Neville is a junior faculty member in the Division of Pulmonary and Critical Care at UCLA who has the long-term goal of using research to improve the quality and appropriateness of care in the intensive care unit (ICU). Her career objective is to become an independent investigator and an academic leader in aging and critical care research. She is currently mentored by Dr. Neil Wenger, who is a well-known health services researcher and the Director of the UCLA Ethics Center. She also has a multi-disciplinary team of well-qualified co-mentors and advisors who will each provide direction in qualitative analysis, statistical modeling, aging research, and intervention development and implementation. Formal courses at UCLA in qualitative methods, aging, implementation science, and biostatistics will complement the guidance she receives from her mentors. She is strongly supported by her division and will be performing her research at UCLA, an institution renowned for its academic, clinical, and research excellence. In this proposal, Dr. Neville seeks to characterize the factors related to older patients receiving inappropriate treatment in the ICU and how physician behavior and system-wide practices might be changed to transition such treatment toward appropriate palliative care. Older patients are the largest growing subset of patients requiring care in the ICU and are vulnerable to the harmful effects of the mismatch of treatment to prognosis. Inappropriate treatment, defined here as a treatment that should not be provided because it does not offer the patient benefit, can prolong suffering, cause family distress, and transform death into an undignified process. This project builds on Dr. Neville's work in defining and quantitating inappropriate treatment in the ICU. It explores and analyzes a previously completed medical record abstraction that she has collected on patients who received inappropriate treatment, patients who received probably inappropriate treatment, and patients who did not receive inappropriate treatment in the ICU. The goal of the proposed project is to 1) use qualitative and quantitative methods to explore the patient, physician, communication, and structural factors related to provision of inappropriate ICU treatment for older critically ill patients, 2) develop and validate a prospective tool to identify patients at rsk of inappropriate treatment at entry into the ICU, and 3) develop and pilot an intervention to decrease inappropriate treatment in the ICU. This application will be a step toward developing interventions that successfully reorient critical care when the prognosis is poor.

 描述（由适用提供）：Thanh Neville博士是UCLA肺部和重症监护部的初级教职员工，他们的长期目标是利用研究来提高重症监护室（ICU）的护理质量和适当性。她的职业目标是成为独立研究者和老龄化和重症监护研究的学术领导者。目前，尼尔·温格（Neil Wenger）博士是著名的卫生服务研究员兼UCLA伦理中心主任尼尔·温格（Neil Wenger）。她还拥有一个由合格的联盟和顾问组成的多学科团队，他们将在定性分析，统计建模，老龄化研究以及干预开发和实施方面提供指导。加州大学洛杉矶分校（UCLA）的正式课程在定性方法，衰老，实施科学和生物统计学方面将完成她从导师那里获得的指导。她的部门得到了强有力的支持，并将在UCLA进行研究，UCLA是一家以其学术，临床和研究卓越研究而闻名的机构。在此提案中，内维尔博士试图表征与ICU中接受不适当治疗的老年患者有关的因素，以及如何将这种治疗转变为适当的姑息治疗的身体行为和全系统范围。老年患者是在ICU中需要护理的患者的最大生长子集，并且容易受到治疗不匹配预后的有害影响。不适当的待遇，此处将其定义为不应提供的治疗方法，因为它不提供患者的利益，可以延长痛苦，造成家庭困扰并将死亡转变为不尊重的过程。该项目基于内维尔博士在定义ICU中定义和定量不适当治疗方面的工作。它探索并分析了她对接受不适当治疗的患者，可能接受不适当治疗的患者以及未接受ICU治疗不当的患者收集的先前完成的医疗记录抽象。 The goal of the proposed project is to 1) use qualitative and quantitative methods to explore the patient, physical, communication, and structural factors related to provision of inappropriate ICU treatment for older critically ill patients, 2) develop and validate a prospective tool to Identify patients at rsk of inappropriate treatment at entry into the ICU, and 3) development and pilot an intervention to decrease inappropriate treatment in the ICU.该应用将是制定干预措施的一步，这些干预措施在预后较差时成功重新定向重症监护。