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.

项目概要/摘要 待解决的临床问题：呼吸衰竭每年导致80万人住院并离开 迄今为止，幸存者处于脆弱状态，其特点是再住院率、残疾率和死亡率都很高。 呼吸衰竭结果的改善主要是通过医院干预措施实现的。 流动护理环境可能是进一步降低发病率和 尽管先前研究这种关系的工作有限，但这种疾病引起的死亡率仍然存在。 这项工作的总体假设是，使用门诊护理可以减少呼吸衰竭的影响 两个关键时间点：降低高危患者的呼吸衰竭发生率以及改善术后呼吸衰竭 幸存者的住院结果。 具体目标：在目标 1 中，Admon 博士将量化以下特征之间的个人层面关联： 为了实现这一目标，他将研究门诊护理的使用情况以及高危患者的呼吸衰竭发生率。 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，同时调整 在目标 2 中，Admon 博士将评估出院后是否存在患者、医院和地区层面的混杂因素。 门诊护理的获取和利用影响呼吸衰竭幸存者的再入院率。 对此进行评估后，他将应用现代流行病学方法来分析卫生部门独特的纵向调查数据 最终，实现这些目标将为实现这些目标奠定基础。 对于后续工作，开发一种基于门诊护理的干预措施，以减少呼吸系统的影响 失败。 研究员培训计划和环境：Admon博士的长期目标是成为一名独立的研究员 通过重症监护健康改善呼吸衰竭患者护理的医师科学家 拟议的奖学金将允许他从事深入的研究，以支持这一目标。 指导研究、教学课程和策划的发展活动，所有这些都是在与他协商后选择的 导师来支持他的特定学术目标，他将通过以下方式奠定坚实的基础。 发展先进统计和流行病学方法、纵向调查数据方面的专业知识， 他的导师在帮助初级教师实现独立方面经验丰富。 学术生涯，并个人致力于支持他的学术和职业发展。