Failure to rescue in frail surgical patients

未能抢救体弱的手术患者

• 批准号: 9162062
• 负责人: Shipra Arya
• 金额: $ 11.7万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9162062
• 关键词: Accounting; Address; Adverse event; Age; Aging; American; American Hospital Association; Anesthetics; Aortic Aneurysm; Award; Blood Vessels; Career Mobility; Caring; Cessation of life; Characteristics; Clinical; Cognitive; Comorbidity; Complication; Consultations; Data; Data Set; Databases; Decision Making; Development; Development Plans; Discipline of Nursing; Educational process of instructing; Elderly; Ensure; Failure; Foundations; Future; Goals; Health; Health Personnel; Health Services; Hemorrhage; Hospital Sizes; Hospitalization; Hospitals; Individual; Inpatients; Intervention; Knowledge; Lead; Life; Link; Literature; Measures; Modeling; Morbidity - disease rate; Nurses; Nutritional; Operative Surgical Procedures; Outcome; Pathway interactions; Patients; Perioperative; Peripheral arterial disease; Physiological; Population; Prevalence; Procedures; Protocols documentation; Public Health; Quality Indicator; Quality of Care; Recovery; Research; Research Personnel; Risk; Risk Factors; Services; Severity of illness; Societies; Specific qualifier value; Stratification; Surgical complication; Syndrome; Thinking; Training; Update; Variant; Work; abstracting; adverse outcome; aged; base; career development; cohort; cost; data registry; design; frailty; functional decline; improved; improved outcome; indexing; individual patient; meetings; mortality; multilevel analysis; older patient; operation; patient population; patient safety; prevent; social; stressor; surgical service; tool

GEMSSTAR R03 Abstract Frailty is the occurrence of decreased reserve and functional decline with resultant vulnerability and poor outcomes in recovery from a stressor usually in older patients. Although frailty is distinct from age, it is highly correlated, and as the US population ages, the prevalence of frailty will likely increase. The growing prevalence of older patient population and frailty will place greater demands on surgical services. One third of all patients aged 65-85 will undergo a major surgical procedure within the last year of life. To provide the best quality of care, it is imperative that healthcare providers and hospitals develop strategies to meet these growing demands and to ensure higher-quality care for geriatric surgical patients. Recent data demonstrate that frailty is a powerful predictor of increased perioperative mortality, morbidity and cost in various surgical populations. Failure to rescue (FTR) refers to a failure to prevent death from treatable complications during hospitalization (e.g. major hemorrhage after surgery) and is used a metric for hospital quality. Our study aims to show that frailty impacts failure to rescue independent of other hospital factors. We also think that certain hospitals are better at rescuing frail patients and we aim to identify characteristics of such hospitals. Although intuitive, this association has not been studied so far. This will be the first study to examine the interplay of frailty, which is primarily a patient characteristic, and FTR- a quality indicator believed to hospital dependent. The proposal also entails a detailed professional development plan with training that will be essential both for successful completion of this research and toward Dr. Arya's career development and transition to aging and surgical quality research. Significant findings from this study will change the way failure to rescue research is used for hospital quality and will lay the groundwork for development of new interventions or protocols on a patient as well as hospital level to improve surgical outcomes in frail patients.

GEMSSTAR R03 摘要 衰弱是指储备能力下降和功能衰退，从而导致脆弱性和贫困 通常在老年患者中从压力源中恢复的结果。虽然衰弱与年龄不同，但它的影响很大 相关，并且随着美国人口老龄化，虚弱的患病率可能会增加。流行率不断上升 老年患者群体的增加和身体虚弱将对外科服务提出更高的要求。三分之一的患者 65-85岁的人将在生命的最后一年内接受重大外科手术。提供最好的品质 护理，医疗保健提供者和医院必须制定战略来满足这些不断增长的需求 需求并确保老年外科患者获得更高质量的护理。最近的数据表明，身体虚弱 是各种手术人群围手术期死亡率、发病率和费用增加的有力预测因素。 抢救失败（FTR）是指在住院期间未能阻止因可治疗的并发症而导致的死亡 （例如手术后大出血）并被用作医院质量的衡量标准。 我们的研究旨在表明，虚弱会影响救援失败，而与其他医院因素无关。我们也 认为某些医院更擅长抢救体弱的患者，我们的目标是确定此类医院的特征 医院。尽管很直观，但迄今为止尚未对这种关联进行研究。这将是第一项研究 虚弱（主要是患者特征）和 FTR（据信是一项质量指标）之间的相互作用 医院依赖者。该提案还包括详细的专业发展计划和培训，该计划将 对于成功完成这项研究以及 Arya 博士的职业发展和 过渡到衰老和手术质量研究。这项研究的重要发现将改变失败的方式 救援研究用于提高医院质量，并将为开发新干预措施奠定基础 或针对患者和医院层面的协议，以改善体弱患者的手术结果。