Economic modeling to understand the relationship between clinicians and outcomes of mechanically ventilated patients

通过经济模型了解临床医生与机械通气患者预后之间的关系

基本信息

批准号：
10636851
负责人：
Meeta Prasad Kerlin
金额：
$ 36.1万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-06-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10636851
关键词：
Accounting Acute Adherence American Care given by nurses Caring Characteristics Clinical Collaborations Critical Illness Discipline of Nursing Dose Economic Models Economics Effectiveness Future Health system Hospital Mortality Hospitals Individual Institution Intensive Care Units Interdisciplinary Study International Intervention Interview K-Series Research Career Programs Knowledge Length of Stay Measurement Measures Mechanical ventilation Mentors Methodology Methods Modeling Morbidity - disease rate Nurses Outcome Patient Admission Patient Care Patient-Focused Outcomes Patients Pennsylvania Performance Physician&apos s Role Physicians Play Policies Population Process Recommendation Research Resources Retrospective cohort study Risk Adjustment Role Sampling Science Scientist Sedation procedure Societies Standardization Structure Techniques Testing Time United States Department of Veterans Affairs United States National Institutes of Health Universities Work acute care brain dysfunction cohort cost economic outcome evidence base high risk high risk population hospital care improved improved outcome individual patient innovation member mortality nurse performance patient population programs provider factors respiratory sedative statistics team-based care tool

项目摘要

PROJECT SUMMARY Up to one million Americans undergo mechanical ventilation (MV) each year and are subject to high rates of morbidity and mortality. Despite the availability of high-quality evidence for therapies that improve outcomes, adherence to best practices and patient outcomes remain variable. MV patients are nearly universally cared for in intensive care units (ICUs), where interprofessional team-based care – involving physicians, respiratory therapists, and nurses, among others – is the norm. Evidence for the benefits of team-based care has driven recommendations from international societies to support this model; however, best practices for team collaboration remain unknown. We have shown that physicians contribute to variability in outcomes of MV patients, and other studies have demonstrated that specific nursing factors are associated with patient outcomes. However, previous studies have not accounted for the entire team in assessment of individual members. An improved understanding of the roles and contributions of different members of an ICU team would inform practices and interventions that could improve patient outcomes in this high risk population. The primary objective of this proposal, therefore, is to better understand the relative contributions of physicians, nurses, and respiratory therapists individually and as teams to outcomes of patients who undergo MV. We will use “value-added modeling” (VAM), an economic approach developed for empirical individual performance measurement when multiple individuals work in a single process. VAM has been validated for measuring performance of acute care nurses and is uniquely suited to this question, in that it accounts for the multiple clinicians that influence outcomes of individual patients. We will achieve our objective through four aims. First, we will apply VAM to model the relationship between clinicians and patient acuity in a broad population of MV patients, in order to estimate relative clinician performance within each professional group. Second, we will compare the contributions of physician, nurse, and respiratory therapist performance based on VAM across a broad range of patient and economic outcomes. We will quantify the contributions of clinician performance relative to patient factors using the omega statistic, a method for estimating the relative variance explained by different variable groups in a multivariable model. Third, we will evaluate the performance of VAM in a second patient population of MV patients admitted to a national sample of Veterans Administration acute care hospitals, and in patients who do not undergo MV, to evaluate the generalizability of VAM methods to estimate clinician performance. Fourth, we will identify clinician and team factors associated with higher performance using a mixed-methods approach. This study will further our understanding of the relative clinician contributions to patient outcomes using innovative modeling techniques, will contribute to the evidence base for team-based care of critically ill patients, will advance the field of team effectiveness, and will directly lead to future work to reduce care variability among the high-risk population of patients who undergo MV.

项目摘要每年多达一百万美国人接受机械通气（MV）发病率和死亡率。尽管有改善预后的疗法的高质量证据，但遵守最佳实践和患者结果仍然可变。 MV患者几乎被普遍照顾重症监护病房（ICU），基于专业团队的护理 - 涉及医生，呼吸系统治疗师和护士等是常态。基于团队护理的好处的证据已驱动国际社会支持该模型的建议；但是，团队的最佳实践协作仍然未知。我们已经表明，医师有助于MV结局的可变性患者以及其他研究表明，特定的护理因素与患者有关结果。但是，以前的研究并未考虑整个团队的评估成员。对ICU团队不同成员的角色和贡献有了深入的了解将为可以改善这种高风险人群的患者预后的实践和干预措施提供信息。这因此，该建议的主要目标是更好地了解医生的相对贡献护士和呼吸治疗师单独，作为接受MV患者的结果的团队。我们将使用“增值建模”（VAM），这是一种用于经验个人绩效的经济方法当多个人在一个过程中工作时的测量。 VAM已被验证用于测量急性护理护士的表现，非常适合这个问题，因为它说明了多个影响个别患者结果的临床医生。我们将通过四个目标来实现我们的目标。第一的，我们将应用VAM来建模临床医生与患者敏锐度之间的关系，其中广泛的MV群体患者，为了估计每个专业组中的相对临床表现。第二，我们会的比较基于VAM的身体，护士和呼吸治疗师的贡献广泛的患者和经济成果。我们将量化临床性能的贡献相对于使用欧米茄统计量的患者因素，一种估计相对方差解释的方法多变量模型中的不同变量组。第三，我们将在第二秒内评估VAM的性能接受退伍军人管理急性护理样本的MV患者的患者群体医院以及不接受MV的患者评估VAM方法的普遍性估计临床表现。第四，我们将确定与较高性能相关的临床和团队因素使用混合方法方法。这项研究将进一步了解我们对相对临床的理解使用创新建模技术对患者结果的贡献将有助于证据基础对于基于团队的重症患者的护理，将提高团队效率领域，并将直接导致未来的工作，以减少接受MV的高危患者人群中的护理变异性。