The Role of Ambulatory Care in Reducing the Burden of Respiratory Failure

门诊护理在减轻呼吸衰竭负担中的作用

• 批准号: 10022147
• 负责人: Andrew John Admon
• 金额: $ 7.59万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10022147
• 关键词: Academic support; Acute respiratory failure; Address; Administrator; Adult Respiratory Distress Syndrome; Affect; Ambulatory Care; Area; Asthma; Caring; Cause of Death; Cessation of life; Characteristics; Chronic Obstructive Airway Disease; Clinical; Congestive Heart Failure; Consultations; Critical Care; Data; Data Set; Data Sources; Development; Disease; Environment; Epidemiologic Methods; Faculty; Fellowship; Foundations; Frequencies; Goals; Graph; Growth; Health Policy; Health Resources; Health Services Accessibility; Health Services Research; Health and Retirement Study; Health system; Hospital Costs; Hospitalization; Hospitals; Improve Access; Individual; Inpatients; Insurance; Intensive Care Units; Intervention; Knowledge; Length of Stay; Link; Long-Term Effects; Longitudinal Surveys; Lung; Mechanical ventilation; Medicare claim; Mentors; Methods; Modernization; Morbidity - disease rate; Outcome; Outpatients; Patient Care; Patients; Physicians; Policies; Population; Primary Health Care; Recovery; Research; Research Personnel; Respiratory Failure; Risk; Role; Scientist; Statistical Methods; Structural Models; Survival Analysis; Survivors; Testing; Time; Training; Work; acute care; base; career; disability; evidence base; experience; health care service; high risk; hospital readmission; improved; longitudinal analysis; member; mortality; prevent; readmission rates; skills; stem; ventilation

PROJECT SUMMARY/ABSTRACT Clinical Problem to be Addressed: Respiratory failure leads to 800,000 hospitalizations per year and leaves survivors in a vulnerable state marked by high rates of rehospitalization, disability, and death. To date, improvements in respiratory failure outcomes have come largely through hospital-based interventions. The ambulatory care environment may represent an additional opportunity to further improve rates of morbidity and mortality stemming from this disease, though prior work examining this relationship has been limited. The overall hypothesis of this work is that the use of ambulatory care reduces the impact of respiratory failure at two key time points: by reducing rates of respiratory failure among patients at risk and by improving post- hospitalization outcomes among survivors. Specific Aims: In aim 1, Dr. Admon will quantify the individual-level association between characteristics of ambulatory care use and rates of respiratory failure among patients at risk. In order to accomplish this, he will apply survival analysis to a dataset of linked inpatient and outpatient Medicare claims while adjusting for patient, hospital, and region-level confounders. In aim 2, Dr. Admon will evaluate whether post-discharge ambulatory care access and utilization influence rates of readmission among survivors of respiratory failure. To assess this, he will apply modern epidemiological methods to the unique, longitudinal survey data in the Health and Retirement Study with linked Medicare claims. Ultimately, accomplishing these aims will lay the foundation for subsequent work developing an ambulatory care-based intervention that reduces the impact of respiratory failure. Fellowship Training Plan and Environment: Dr. Admon’s long-term goal is to become an independent physician-scientist who improves the care of patients with respiratory failure through critical care health services research. The proposed fellowship will support this goal by allowing him to engage in intensive mentored research, didactic coursework, and curated development activities, all chosen in consultation with his mentors to support his particular academic goals. In doing so, he will build on a strong foundation by developing expertise in advanced statistical and epidemiological methods, longitudinal survey data, and ambulatory claims. His mentors are experienced in helping junior faculty members achieve independent academic careers and are personally committed to supporting his academic and professional growth.

项目摘要/摘要 临床问题要解决：呼吸衰竭每年导致80万住院 脆弱状态的幸存者以高回复，残疾和死亡的速度为标志。迄今为止， 呼吸衰竭结果的改善主要是通过基于医院的干预措施来进行的。这 门诊护理环境可能代表了进一步提高发病率和 由于这种疾病的死亡率，尽管先前检查这种关系的工作受到限制。这 这项工作的总体假设是使用门诊护理减少了呼吸衰竭的影响 两个关键时间点：通过降低处于危险的患者的呼吸衰竭率并改善后 存活率之间的住院结果。 具体目的：在AIM 1中，Admon博士将量化个人级别的关联 处于危险的患者中的门诊护理和呼吸衰竭率。为了实现这一目标，他将 在调整时，将生存分析应用于链接的住院和门诊医疗保险索赔的数据集 病人，医院和地区级别的混杂因素。在AIM 2中，Admon博士将评估是否出院后是否 门诊护理的获取和利用会影响呼吸衰竭存活率之间的再入院率。到 评估这一点，他将把现代流行病学方法应用于健康中独特的纵向调查数据 和通过链接的Medicare主张的退休研究。最终，实现这些目标将奠定基础 为了开发基于门诊护理的干预措施，以减少呼吸系统的影响 失败。 奖学金培训计划和环境：Admon博士的长期目标是成为独立 身体科学家通过重症监护健康改善呼吸衰竭患者的护理 服务研究。拟议的奖学金将通过允许他进行密集来支持这一目标 指导研究，教学课程和策划的发展活动，所有这些都与他的 指导他的特定学术目标。这样，他将以坚实的基础为基础 在高级统计和流行病学方法，纵向调查数据以及 卧床要求。他的导师在帮助初级教职员工实现独立方面经验丰富 学术职业，并亲自致力于支持他的学术和职业成长。