Developing a Novel Decision Aid for Tracheostomy to Support Shared Decision- Making in the Intensive Care Unit

开发新型气管造口决策辅助工具，支持重症监护病房的共同决策

基本信息

批准号：
10657564
负责人：
Anuj Mehta
金额：
$ 16.25万
依托单位：
DENVER HEALTH AND HOSPITAL AUTHORITY
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：
2021-02-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10657564
关键词：
Accounting Acute Advisory Committees Agreement Award Big Data Bite California Caring Cessation of life Chronic lung disease Clinical Clinical Research Colorado Conflict (Psychology)Consensus Critical Care Critical Illness Data Decision Aid Decision Making Delirium Development Emotional Ensure Environment Family Foundations Frustration Goals Health Health Care Costs Health Personnel Health Services Research Healthcare Home Hospital Planning Influentials Institution Intensive Care Units International Interview K-Series Research Career Programs Knowledge Life Link Long-Term Care Lung Mechanical ventilation Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Methods Modeling Morbidity - disease rate Mosses National Heart, Lung, and Blood Institute Needs Assessment Online Systems Outcome Patient Care Patient Discharge Patient Selection Patient-Centered Care Patients Penetration Physicians Pneumonia Procedures Process Prognosis Publications Qualifying Qualitative Methods Qualitative Research Recommendation Regrets Reporting Research Research Methodology Research Personnel Resources Respiratory Failure Risk Science Scientist Severity of illness Societies Statistical Models Structure Techniques Time Tracheostomy procedure Training Training and Education Tube United States Universities Ventilator Weaning Vital Statistics Work career caregiver stress demographics endotracheal expectation experience follower of religion Jewish hospital readmission improved improved outcome innovation life-sustaining therapy long term hospitalization mortality multidisciplinary novel outcome prediction patient oriented personalized decision personalized predictions population based predictive modeling preference risk prediction model shared decision making success support tools surrogate decision maker tool uptake vocal cord web based decision aid

项目摘要

PROJECT SUMMARY/ABSTRACT This NHLBI K23 Mentored Patient-Oriented Research Career Development Award (PA-18-374) submission by Anuj B. Mehta, MD will enable him to achieve his overarching career goal of improving shared decision-making (SDM) in the intensive care unit (ICU) by combining qualitative research methodologies with ‘big data’. Dr. Mehta is a Pulmonary and Critical Care Physician at National Jewish Health. This award will build on Dr. Mehta’s prior health services research in delivery science and provide him with protected research time and support to pursue advanced education and training in 1) qualitative research 2) advanced statistical methodologies in health services research, 3) SDM, and 4) decision aid development. With this proposal, we seek improve SDM for tracheostomy by developing and piloting a personalized decision aid (AIM 3) with a qualitative decisional needs assessment through semi-structured interviews of surrogate decision-makers (AIM 1) and development of tailored tracheostomy prediction models (AIM 2). The dramatic increases in tracheostomy utilization that we have previously reported has large personal and societal implications. Patients who receive a tracheostomy overwhelmingly require long-term hospitalization with significant morbidity, mortality, long-term care needs, and caregiver stress. Evidence suggests that there is large patient and surrogate frustration with the decision-making process with significant decision conflict, misalignment of care delivered with patient values, and discordance between surrogates’ expectations and actual outcomes. These findings raise the possibility that patients may be receiving unwanted, invasive, and expensive care not consistent with their underlying values. SDM is the collaborative process of patients, surrogates, and healthcare providers reaching an informed, collective agreement on the treatments consistent with patient’s values. Decision aids are a key tool with which to facilitate SDM. SDM and decisions have been shown to improve the patient-centeredness of care, improve patient knowledge of treatment options and possible outcomes, better align chosen treatments with patient values, and reduce decisional regret and conflict. Multiple societies now recommend that SDM be a cornerstone of patient centered care in the ICU bit its penetration and uptake are limited. We hypothesize that a personalized web based decision aid for tracheostomy will improve the shared decision making process. Dr. Mehta has strong institutional support from National Jewish Health. Dr. Mehta has assembled a team of mentors well suited to ensuring his success during this Career Development Award led by Dr. Ivor Douglas and Dr. Daniel Matlock. Dr. Mehta’s work will serve as model for developing SDM tools in the ICU. Dr. Mehta’s proposed training and research will directly impact patient care related to tracheostomy by improving SDM, and better aligning the care received with patient and surrogate values.

项目摘要/摘要该NHLBI K23指导了以患者为导向的研究职业发展奖（PA-18-374）提交医学博士Anuj B. Mehta将使他实现自己的总体职业目标，以改善共同的决策（SDM）在重症监护室（ICU）中，通过将定性研究方法与“大数据”相结合。博士 Mehta是国家犹太人健康的肺和重症监护医师。该奖项将基于博士。 Mehta先前在交付科学领域的健康服务研究，并为他提供受保护的研究时间和支持购买高级教育和培训1）定性研究2）高级统计卫生服务研究的方法，3）SDM和4）决策援助开发。有了这个建议，我们通过开发和试行个性化决策援助（AIM 3），寻求改进SDM进行气管造口术通过替代决策者的半结构化访谈进行定性决策需求评估（AIM 1）并开发量身定制的气管切开术预测模型（AIM 2）。戏剧性的增加我们以前报道的气管造口术利用具有巨大的个人和社会影响。患者在压倒多数的人中需要长期住院，并具有明显的发病率，死亡率，长期护理需求和护理人员压力。有证据表明有大型患者对决策过程的替代挫败感，严重决策冲突，护理失败以患者的价值观和代孕期望和实际结果之间的不一致交付。这些调查结果增加了患者可能接受不必要，侵入性和昂贵的护理的可能性与它们的基本值一致。 SDM是患者，代理和医疗保健提供者达成了与患者的治疗方面的知情，集体协议值。决策辅助工具是促进SDM的关键工具。 SDM和决定已被证明提高以患者为中心的护理，提高患者对治疗选择的了解和可能结果，更好地使选择的治疗方法与患者价值观保持一致，并减少决策性的遗憾和冲突。现在，多个社会建议SDM成为ICU中以患者为中心护理的基石。渗透和吸收有限。我们假设一个个性化的基于Web的决策援助气管切开术将改善共同的决策过程。 Mehta博士得到了来自国家犹太人健康。 Mehta博士组建了一支非常适合确保成功的导师团队在这个职业发展奖中，由艾沃尔·道格拉斯（Ivor Douglas）博士和丹尼尔·马特洛克（Daniel Matlock）博士领导。 Mehta博士的工作将充当ICU中开发SDM工具的模型。 Mehta博士的提议培训和研究将直接通过改善SDM来影响与气管造口术有关的患者护理，并更好地对齐接受的护理患者和替代价值。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Variation in Do-Not-Resuscitate Orders and Implications for Heart Failure Risk-Adjusted Hospital Mortality Metrics.

DOI：
10.1016/j.jchf.2017.07.010
发表时间：
2017-10
期刊：
JACC. Heart failure
影响因子：
0
作者：
Bruckel J;Mehta A;Bradley SM;Thomas S;Lowenstein CJ;Nallamothu BK;Walkey AJ
通讯作者：
Walkey AJ

Prognosis for Mechanically Ventilated Patients: A Moving Target.

机械通气患者的预后：移动目标。

DOI：
10.1513/annalsats.202003-242ed
发表时间：
2020
期刊：
Annals of the American Thoracic Society
影响因子：
8.3
作者：
Zaeh,SandraE;Mehta,AnujB
通讯作者：
Mehta,AnujB

Informing Healthcare Decisions with Observational Research Assessing Causal Effect. An Official American Thoracic Society Research Statement.

DOI：
10.1164/rccm.202010-3943st
发表时间：
2021-01-01
期刊：
American journal of respiratory and critical care medicine
影响因子：
24.7
作者：
Gershon AS;Lindenauer PK;Wilson KC;Rose L;Walkey AJ;Sadatsafavi M;Anstrom KJ;Au DH;Bender BG;Brookhart MA;Dweik RA;Han MK;Joo MJ;Lavergne V;Mehta AB;Miravitlles M;Mularski RA;Roche N;Oren E;Riekert KA;Schoenberg NC;Stukel TA;Weiss CH;Wunsch H;Africk JJ;Krishnan JA
通讯作者：
Krishnan JA

Disparities in Adult Patient Selection for Extracorporeal Membrane Oxygenation in the United States: A Population-Level Study.

美国成人患者体外膜氧合选择的差异：一项人群水平研究。