Identifying palliative care needs among hospitalized patients with chronic obstructive pulmonary disease

确定慢性阻塞性肺疾病住院患者的姑息治疗需求

基本信息

批准号：
10004708
负责人：
Katherine Rinaldi Courtright
金额：
$ 17.36万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-15 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10004708
关键词：
Address Adherence Advocate Age American Award Beds Bioinformatics Calibration Caregivers Caring Cessation of life Characteristics Chronic Obstructive Airway Disease Classification Clinical Clinical Research Consult Cross-Sectional Studies Data Data Reporting Data Sources Development Discrimination Disease Distress Education Educational process of instructing Effectiveness Electronic Health Record Enrollment Ensure Fellowship Future Goals Health Policy Hospitals Inpatients Institution Intensive Care Units Intervention K-Series Research Career Programs Knowledge Machine Learning Manuals Marital Status Medical Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Modeling National Heart, Lung, and Blood Institute Natural Language Processing Nurses Observational Study Outcome Outcomes Research Palliative Care Participant Patient Care Patient Outcomes Assessments Patient risk Patient-Focused Outcomes Patients Performance Persons Physicians Policy Research Postdoctoral Fellow Prevalence Probability Process Professional Organizations Pulmonary Heart Disease Quality of life Reference Standards Reporting Research Research Design Research Personnel Research Training Resources Retrospective cohort study Risk Sampling Site Social Work Social support Structure Surveys Symptoms Testing Text Time TimeLine Training Triage Validation Visit Vulnerable Populations Work base career clinical center clinically actionable clinically relevant cohort comorbidity end of life end of life care experience functional status hospital services improved improved outcome innovation machine learning method medical specialties novel patient oriented physical symptom prospective psychosocial randomized trial readmission rates recruit skills study population supportive environment unstructured data uptake

项目摘要

PROJECT SUMMARY Millions of Americans with COPD experience burdensome symptoms, reduced quality of life, and undesirable end-of-life care. Increasing palliative care for this vulnerable population is widely advocated to improve these important patient-centered outcomes. Yet patients with COPD rarely receive palliative care due, in part, to difficulties identifying which patients have unmet palliative care needs and palliative care workforce shortages. The proposed study's core objective is to address the national priority of improving palliative care for patients with COPD by developing an efficient, innovative, and patient-centered method to identify those with unmet palliative care needs. Specifically, the candidate seeks to (1) assess patients with COPD to determine their palliative care needs; (2) develop and validate an electronic health record-based classification model for each domain of palliative care needs; and (3) evaluate the relationship between the probability of having unmet palliative care needs and patient-centered clinical outcomes. The study will involve an in-person cross- sectional survey of 432 hospitalized patients with COPD of any stage. Participants will complete a validated survey to capture a wide variety of palliative care needs, which will be supplemented with expert chart review to identify patients with needs in any of three clinically relevant and actionable domains. These cases will be used as the patient-reported reference standard for development and validation of domain-specific classification models leveraging natural language processing of unstructured clinical text in electronic health records and machine learning methods. Finally, a large, multicenter retrospective cohort study will evaluate the associations between different probabilities of having unmet palliative care needs and several clinical outcomes important to patients, caregivers, and hospitals. This will enable the identification of thresholds of probabilities of unmet needs above which COPD patients' risks of undesirable clinical outcomes increase. Such patients will then be targeted for enrollment in future trials testing interventions to improve these outcomes. Completion of this research will build upon the candidate's past training, which includes a Masters in Health Policy Research obtained with NHLBI T32 support, an F32-supported post-doctoral fellowship, and a career development award from the National Palliative Care Research Center, and will provide the experience, education, and mentorship to allow the candidate to become a fully independent investigator. The candidate's rigorous training plan, focused on obtaining advanced skills in multisite prospective research, patient-centered outcomes research, and advanced bioinformatics methods will allow her to submit successful R01 or PCORI applications testing interventions directly informed by the results of this work. The candidate's primary mentor, collaborators, and advisors will ensure adherence to the proposed timeline and goals and provide a supportive environment for her to develop an independent research career focused on improving the uptake and effectiveness of palliative care for patients with COPD and other cardiopulmonary diseases.

项目摘要数百万患有COPD的美国人经历了繁重的症状，生活质量降低和不良临终护理。广泛提倡对这一脆弱人群的姑息治疗增加来改善这些重要的以患者为中心的结果。然而，患有COPD的患者很少接受姑息治疗，部分原因是难以确定哪些患者的姑息治疗需求和姑息治疗劳动力短缺。拟议的研究的核心目标是解决改善患者姑息治疗的国家优先事项通过开发一种有效，创新和以患者为中心的方法来识别那些未得到满足的方法，通过COPD 姑息治疗需求。具体而言，候选人试图（1）评估COPD患者以确定其姑息治疗需求；（2）为每个开发并验证一个基于电子健康记录的分类模型姑息治疗需求的领域；（3）评估未安装的概率之间的关系姑息治疗需求和以患者为中心的临床结果。该研究将涉及一个面对面的交叉对432名任何阶段COPD的住院患者的分区调查。参与者将完成经过验证的调查以捕获各种各样的姑息治疗需求，并补充专家图表评论在三个临床相关且可操作的领域中的任何一个中都有需求的患者。这些情况将是用作患者报告的参考标准，用于开发和验证域特异性利用电子健康中非结构化临床文本的自然语言处理的分类模型记录和机器学习方法。最后，一项大型多中心回顾性队列研究将评估具有未满足姑息治疗需求的不同概率与几个临床之间的关联结果对患者，看护人和医院很重要。这将使能够识别未满足需求的概率，高于COPD患者的不良临床结果风险增加。然后，此类患者将被针对以后的试验测试干预措施的入学人数结果。这项研究的完成将基于候选人的过去培训，其中包括硕士在NHLBI T32支持的卫生政策研究中，F32支持的博士后奖学金和A 国家姑息治疗研究中心的职业发展奖，将提供体验教育和指导使候选人成为完全独立的调查员。候选人的严格的培训计划，专注于获得以患者为中心的多站点前瞻性研究的高级技能结果研究和高级生物信息学方法将使她能够提交成功的R01或PCORI 该工作结果直接告知了应用程序测试干预措施。候选人的主要导师，合作者和顾问将确保遵守提议的时间表和目标，并提供支持她发展独立研究职业的环境，专注于改善吸收和姑息治疗对COPD和其他心肺疾病患者的有效性。