Abdominal Pain in Older Patients in Emergency Departments

急诊科老年患者的腹痛

基本信息

批准号：
10739136
负责人：
Ari B Friedman
金额：
$ 19.49万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-15 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10739136
关键词：
Abdomen Abdominal Pain Abdominal Radiography Accident and Emergency department Acute Acute Disease Admission activity Adult Affect Age Aging Alzheimer&apos s disease related dementia Analgesics Award Benign Biological Models Caring Cessation of life Cognitive Communication Barriers Data Data Collection Data Sources Delirium Dementia Development Plans Diagnosis Diagnostic tests Disease Disparity population Doctor of Philosophy Elderly Electrocardiogram Electronic Health Record Emergency Care Emergency Department Physician Emergency Department patient Emergency Medicine Emergency department visit Emergent care Enrollment Environment Equilibrium Evaluation Face Faculty Fostering Funding Future Geriatrics Gerontology Goals Health Health Services Research Hospitalization Hospitals Impaired cognition Infection Infrastructure Institution Intestinal Obstruction Ischemia K-Series Research Career Programs Knowledge Link Longitudinal cohort Measurement Measures Mediating Medical Medicare Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Mesentery Morbidity - disease rate Myocardial Infarction Natural History Neurocognitive Outcome Pain Pathway interactions Patient Admission Patient Care Patients Patterns of Care Pennsylvania Persons Physical Function Physiological Quality of Care Race Research Research Personnel Resources Risk Scholarship Science Secure Sociology Source Structure Symptoms Syndrome System Testing Time Training Trauma Triage Universities Variant Visit Work X-Ray Computed Tomography care seeking care systems career career development clinical practice cognitive function cohort disparity reduction emergency settings frailty health disparity health economics high risk human old age (65+)improved mild cognitive impairment mortality mortality risk multiple chronic conditions older patient pain patient patient population patient subsets poor health outcome prospective sex side effect skill acquisition skills success

项目摘要

PROJECT SUMMARY/ABSTRACT Candidate: Ari B. Friedman, MD, PhD is junior faculty at the University of Pennsylvania (Penn). He practices clinically as an emergency physician and conducts research as a health economist into how care systems affect patients' lives. He is passionate about improving the care and outcomes of the many older patients that he sees in the emergency department (ED) by improving the science underlying that care. Goal: The purpose of this K23 Career Development Award is to enable Dr. Friedman to gain knowledge and skills necessary to become an independent investigator focusing on the emergent care of older patients. Research Context: Visits to hospital EDs are a growing source of care for adults over 65, totaling 22.4 million visits in 2017. Among older patients, abdominal pain is the single most common chief complaint. Simply being over 65 years, presenting to an ED, and stating at triage, “I have abdominal pain,” as a chief complaint confers a mortality rate as high or higher than an ST-Elevation Myocardial Infarction (STEMI), with equivalently high morbidity. Yet little is known about this phenomenon, especially for patients with frailty or cognitive impairment. Career Development Plan: Dr. Friedman seeks training in frailty, cognitive impairment and dementia, geriatrics, primary data collection, and health disparities. This award will provide protected time for Dr. Friedman to acquire the skills necessary to secure independent funding through a progressive, milestone- driven training plan that includes coursework, mentored research, and guided independent study. Aims: The central hypothesis of this proposal is that there are identifiable ways to improve the evaluation and management of abdominal pain among older patients in the ED. Dr. Friedman will use the training funded by this Mentored Patient-Oriented Research Career Development Award to examine variation in ED abdominal pain testing, management, disposition, and outcomes overall and among patients with frailty, cognitive impairment, among disadvantaged populations, and in periods when resources do not meet demand. Research Plan: These Aims will be carried out by using primary data collected through the proposed ED Geriatric Abdominal Pain (ED-GAP) cohort with additional variables from the Penn Electronic Health Record (EHR). This data will capture both management and outcomes for admitted patients and contains measurements of essential factors associated with aging. Retrospective EHR data of abdominal pain visits to 6 EDs over 8 years will also be used. Multivariate regression will test the hypotheses above. Environment: Senior researchers with an established track record of mentoring scholars from their early career to independent and impactful work are committed to Dr. Friedman's success. This team is embedded within a university environment with a track record of collaborative, pathbreaking scholarship in health economics, health services research, emergency medicine, and gerontology.

项目概要/摘要候选人：Ari B. Friedman，医学博士、哲学博士，宾夕法尼亚大学 (Penn) 的初级教师。作为一名急诊医生进行临床治疗，并作为一名健康经济学家对护理系统如何进行研究他热衷于改善许多老年患者的护理和结果。他通过改进急诊科 (ED) 护理基础的科学来进行治疗。目标：设立 K23 职业发展奖的目的是让弗里德曼博士获得知识并成为专注于老年患者紧急护理的独立研究者所需的技能。研究背景：前往医院急诊室就诊的 65 岁以上成年人越来越多，总计 2,240 万人次 2017 年就诊。在老年患者中，腹痛是最常见的主诉。超过 65 岁，向急诊科就诊，并在分诊时表示，“我有腹痛”，这是主诉所赋予的死亡率与 ST 段抬高型心肌梗死 (STEMI) 一样高或更高，然而，人们对这种现象知之甚少，特别是对于患有虚弱或认知障碍的患者。职业发展计划：弗里德曼博士寻求有关虚弱、认知障碍和痴呆症的培训，该奖项将为老年病学、主要数据收集和健康差异提供保护。弗里德曼将获得必要的技能，通过一个渐进的、里程碑式的项目来获得独立资金—— 驱动型培训计划，包括课程作业、指导研究和指导独立学习。目标：该提案的中心假设是，有可识别的方法来改进评估和弗里德曼博士将使用由 ED 资助的培训来管理老年患者的腹痛。这项以患者为导向的研究职业发展奖旨在检查 ED 腹部的变化疼痛测试、管理、处置和总体结果，以及患有虚弱、认知障碍的患者弱势群体中以及资源不能满足需求的时期。研究计划：这些目标将通过使用通过拟议的 ED 收集的主要数据来实现老年腹痛 (ED-GAP) 队列以及宾夕法尼亚大学电子健康记录中的其他变量 (EHR)。该数据将捕获入院患者的管理和结果，并包含与衰老相关的重要因素的测量 6 次腹痛就诊的回顾性 EHR 数据。还将使用 8 年以上的 ED 来检验上述假设。环境：资深研究人员从早期就指导学者有良好的记录弗里德曼博士的成功离不开从职业生涯到独立且有影响力的工作。在大学环境中拥有合作、开创性的健康奖学金记录经济学、卫生服务研究、急诊医学和老年学。