The role of physician experience in outcomes of patients with acute respiratory f

医生经验对急性呼吸道疾病患者预后的影响

基本信息

批准号：
9301632
负责人：
Meeta Prasad Kerlin
金额：
$ 16.98万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-01 至 2018-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9301632
关键词：
Acute Acute respiratory failure Adopted Aptitude Caring Clinical Clinical Research Complex Critical Care Critical Illness Data Data Set Databases Development Development Plans Education Ensure Evidence based practice Exposure to Foundations Future Goals Health Policy Hospitals Individual Intervention Journals K-Series Research Career Programs Knowledge Learning Link Literature Lung Master of Science Measurable Mechanical ventilation Mechanics Medicine Mentors Mentorship Methodology Modeling Morbidity - disease rate Motivation Operative Surgical Procedures Outcome Outcomes Research Patient Care Patient-Focused Outcomes Patients Pennsylvania Physician&apos s Role Physicians Provider Publications Research Research Infrastructure Research Personnel Research Project Grants Resources Retrospective cohort study Role Science Statistical Models Structure Surveys Techniques Testing Training Translating Translations Universities University resources Variant Work base career development clinical epidemiology clinical practice experience high risk improved improved outcome innovation insight interest knowledge translation mortality novel patient population public health relevance respiratory skills uptake

项目摘要

DESCRIPTION (provided by applicant): Patients with acute respiratory failure requiring mechanical ventilation are at high risk for morbidity and mortality. Although several recent advances have improved management of such patients, these therapies have been incompletely adopted and patient outcomes continue to vary across hospitals. One factor that may be associated with improved translation of evidence into practice is the experience of the physician provider. Previous studies indirectly provide evidence for this relationship; for example, higher annual hospital volume is associated with reduced mortality. However, there is little direct evidence, physician "experience" has not been defined, and the capacity of organizational solutions to modify the relationship is unknown. A better understanding of this complex relationship could reveal novel targets for interventions to improve uptake of evidence-based practices of mechanically ventilated patients and ultimately their outcomes. Therefore the overall goal of this proposal is to understand the relationship between physician experience and outcomes for mechanically ventilated patients. Specifically, we will determine (1) if there is an association of physician experience, defined as years since completing of training, with patient outcomes; (2) the relative contributions of physician experience and hospital volume to patient outcomes; and (3) if effects of physician experience are modified by the presence of organizational factors. For this project we will create an innovative database linking multiple publicly available administrative and clinical datasets of patients hospitalized in the state of Pennsylvania with data obtained from a state-wide hospital survey and will use state-of-the-art statistical modeling techniques to advance our understanding of the role of the physician in patient outcomes. This database and career development award will be a foundation for the candidate's future work as an independent clinical researcher with a focus on developing and implementing organizational interventions to improve care of patients with acute respiratory failure. Dr. Meeta Prasad Kerlin has a clinical background in pulmonary and critical care medicine and a Master of Science in Clinical Epidemiology from the University of Pennsylvania. She has demonstrated her interest and aptitude for clinical research through the successful completion of several research projects in the topics of critical care outcomes and education. She has had multiple publications in high-impact journals such as JAMA and Critical Care Medicine. In this proposal, she has developed a career development plan that includes a complementary approach of didactic learning, structured professional development, intensive mentorship, and direct research experience leading the project described above. She has the full support of her department, outstanding mentors who are already the leaders in critical care outcomes research, and access to the vast resources of the University of Pennsylvania. Together, these will ensure her successful development into a leader in her own right.

描述（由申请人提供）：需要机械通气的急性呼吸衰竭患者发病和死亡的风险很高。尽管最近的一些进展改善了此类患者的管理，但这些疗法尚未得到完全采用，并且不同医院的患者结果仍然存在差异。可能与改进证据转化为实践相关的因素之一是医生的经验。之前的研究间接为这种关系提供了证据；例如，每年住院人数增加与死亡率降低相关。然而，直接证据很少，医生的“经验”尚未定义，组织解决方案修改关系的能力也是未知的。更好地理解这种复杂的关系可以揭示新的干预目标，以改善机械通气患者对循证实践的采用，并最终改善其结果。因此，该提案的总体目标是了解医生经验与机械通气患者的结果之间的关系。具体来说，我们将确定（1）医生经验（定义为完成培训后的年数）是否与患者结果存在关联； (2) 医生经验和医院规模对患者治疗结果的相对贡献； (3) 医生经验的影响是否因组织因素的存在而改变。对于这个项目，我们将创建一个创新的数据库，将宾夕法尼亚州住院患者的多个公开可用的管理和临床数据集与从全州医院调查中获得的数据联系起来，并将使用最先进的统计建模技术来推进我们对医生在患者治疗结果中的作用的理解。该数据库和职业发展奖将为候选人未来作为独立临床研究人员的工作奠定基础，重点是开发和实施组织干预措施，以改善急性呼吸衰竭患者的护理。 Meeta Prasad Kerlin 博士拥有肺科和重症监护医学的临床背景以及宾夕法尼亚大学临床流行病学理学硕士学位。通过成功完成多个重症监护结果和教育主题的研究项目，她表现出了对临床研究的兴趣和天赋。她在《JAMA》和《重症监护医学》等高影响力期刊上发表过多篇论文。在这份提案中，她制定了一份职业发展计划，其中包括教学学习、结构化专业发展、强化指导以及领导上述项目的直接研究经验的补充方法。她得到了她所在部门的全力支持，拥有已经成为重症监护结果研究领导者的杰出导师，并获得了宾夕法尼亚大学的丰富资源。总之，这些将确保她成功发展成为一名独立的领导者。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Physician-Level Variation in Outcomes of Mechanically Ventilated Patients.

机械通气患者的结果的医生水平差异。

DOI：
发表时间：
2018
期刊：
影响因子：
8.3
作者：
Kerlin, Meeta Prasad;Epstein, Andrew;Kahn, Jeremy M;Iwashyna, Theodore J;Asch, David A;Harhay, Michael O;Ratcliffe, Sarah J;Halpern, Scott D
通讯作者：
Halpern, Scott D

24-Hour Intensivist Staffing Is Not Beneficial for Patients.

24 小时重症监护室人员配置对患者没有好处。

DOI：
发表时间：
2018-01
期刊：
影响因子：
8.8
作者：
Kerlin; Meeta Prasad
通讯作者：
Meeta Prasad

Nighttime physician staffing improves patient outcomes: no.

夜间医生配备可以改善患者的治疗效果：不会。

DOI：
发表时间：
2016-09
期刊：
影响因子：
38.9
作者：
Kerlin, Meeta Prasad;Halpern, Scott D
通讯作者：
Halpern, Scott D

Procedure-specific consent is the norm in United States intensive care units.

在美国重症监护病房，特定程序同意是常态。

DOI：
发表时间：
2016-10
期刊：
影响因子：
38.9
作者：
Weiss, Elliott Mark;Kohn, Rachel;Madden, Vanessa;Halpern, Scott;Joffe, Steven;Kerlin, Meeta Prasad
通讯作者：
Kerlin, Meeta Prasad

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Meeta Prasad Kerlin其他文献

Acute Gastrointestinal Bleeding

急性胃肠道出血

DOI：
发表时间：
2013
期刊：
Annals of Internal Medicine
影响因子：
39.2
作者：
Meeta Prasad Kerlin;Jeffrey L. Tokar
通讯作者：
Jeffrey L. Tokar

Burnout, and Fulfillment, in the Profession of Critical Care Medicine.

重症监护医学专业的倦怠和成就感。

DOI：
10.1164/rccm.201903-0662le
发表时间：
2019-10-01
期刊：
American journal of respiratory and critical care medicine
影响因子：
24.7
作者：
M. Mikkelsen;B. Anderson;L. Bellini;W. Schweickert;B. Fuchs;Meeta Prasad Kerlin
通讯作者：
Meeta Prasad Kerlin

A “placement of death” approach for studies of treatment effects on ICU length of stay

研究治疗对 ICU 住院时间影响的“死亡安置”方法

DOI：
10.1177/0962280214545121
发表时间：
2017-02-01
期刊：
Statistical Methods in Medical Research
影响因子：
2.3
作者：
Winston T. Lin;S. Halpern;Meeta Prasad Kerlin;Dylan S. Small
通讯作者：
Dylan S. Small

Potentially Preventable Intensive Care Unit Admissions in the United States, 2006 - 2015.

2006 年至 2015 年美国重症监护病房入院情况可预防。

DOI：
10.1513/annalsats.201905-366oc
发表时间：
2020-01-01
期刊：
Annals of the American Thoracic Society
影响因子：
8.3
作者：
G. Weissman;Meeta Prasad Kerlin;Yihao Yuan;R. Kohn;G. Anesi;P. Groeneveld;R. Werner;S. Halpern
通讯作者：
S. Halpern