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.

项目概要/摘要 NHLBI K23 指导的以患者为导向的研究职业发展奖 (PA-18-374) 提交者 Anuj B. Mehta 医学博士将使他能够实现改善共同决策的总体职业目标通过将定性研究方法与“大数据”相结合，在重症监护病房（ICU）中开展 SDM。梅塔是国家犹太健康中心的一名肺科和重症监护医师，该奖项将建立在梅塔博士的基础上。梅塔之前在分娩科学方面的健康服务研究，为他提供了受保护的研究时间和支持在 1) 定性研究 2) 高级统计方面进行高级教育和培训卫生服务研究方法论、3) SDM 和 4) 决策辅助开发通过此提案，我们。通过开发和试点个性化决策辅助 (AIM 3)，寻求改进气管切开术的 SDM 通过代理决策者的半结构化访谈进行定性决策需求评估（AIM 1) 并开发定制的气管切开术预测模型 (AIM 2)。我们之前报道过的气管切开术的使用对患者具有巨大的个人和社会影响。接受气管切开术的患者绝大多数需要长期住院治疗，且发病率很高，有证据表明，存在大量患者和护理人员的压力。代孕妈妈对决策过程感到沮丧，存在重大决策冲突、护理不一致传达患者价值观，以及代理人的期望与实际结果之间的不一致。研究结果提出了一种可能性，即患者可能正在接受不必要的、侵入性的和昂贵的护理，而不是 SDM 是患者、代理人和代理人的协作过程，与其基本价值观相一致。医疗保健提供者就符合患者情况的治疗达成知情的集体协议决策辅助工具是促进 SDM 和决策的关键工具。提高以患者为中心的护理，提高患者对治疗方案和可能的了解结果，更好地将选择的治疗方法与患者价值观结合起来，并减少决策后悔和冲突。多个协会现在建议 SDM 成为 ICU 中以患者为中心的护理的基石我们利用基于网络的个性化决策帮助来实现这一目标。气管切开术将改善共同决策过程，梅塔博士得到了强有力的机构支持。梅塔博士组建了一支非常适合确保他成功的导师团队。在艾弗·道格拉斯博士和丹尼尔·马特洛克博士领导的职业发展奖期间，梅塔博士的工作将得到表彰。 Mehta 博士提出的培训和研究将直接作为在 ICU 中开发 SDM 工具的模型。通过改进 SDM 并更好地调整所接受的护理，影响与气管切开术相关的患者护理患者值和替代值。

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）

Prognosis for Mechanically Ventilated Patients: A Moving Target.

机械通气患者的预后：移动目标。

DOI：
发表时间：
2020
期刊：
影响因子：
8.3
作者：
Zaeh, Sandra E;Mehta, Anuj B
通讯作者：
Mehta, Anuj B

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

通过评估因果效应的观察研究为医疗决策提供信息。

DOI：
发表时间：
2021-01-01
期刊：
影响因子：
24.7
作者：
Gershon, Andrea S;Lindenauer, Peter K;Wilson, Kevin C;Rose, Louise;Walkey, Allan J;Sadatsafavi, Mohsen;Anstrom, Kevin J;Au, David H;Bender, Bruce G;Brookhart, M Alan;Dweik, Raed A;Han, MeiLan K;Joo, Min J;Lavergne, Valery;Mehta, Anuj B;Mira
通讯作者：
Mira

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

不复苏命令的变化及其对心力衰竭风险调整医院死亡率指标的影响。

DOI：
发表时间：
2017-10
期刊：
影响因子：
0
作者：
Bruckel, Jeffrey;Mehta, Anuj;Bradley, Steven M;Thomas, Sabu;Lowenstein, Charles J;Nallamothu, Brahmajee K;Walkey, Allan J
通讯作者：
Walkey, Allan J

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。