Research Project 3

研究项目3

• 批准号: 10159134
• 负责人: Christopher Ethan Cox
• 金额: $ 21.25万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-25 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10159134
• 关键词: Academy; Address; Admission activity; Adult; African American; Attention; Caring; Communication; Data; Decision Making; Effectiveness of Interventions; Environment; Ethnic Origin; Family; Family member; Focus Groups; Frequencies; Future; Goals; Healthcare; Intensive Care Units; Intervention; Interview; Lead; Length of Stay; Medicine; Methods; Outcome; Palliative Care; Patient Care; Patient Self-Report; Patient-Centered Care; Patients; Perception; Pilot Projects; Population Heterogeneity; Pragmatic clinical trial; Preparation; Process; Process Measure; Provider; Quality of Care; Race; Reporting; Research; Research Project Grants; Series; Service delivery model; Structure; Symptoms; System; Technology; Testing; United States National Institutes of Health; base; black patient; care coordination; care delivery; caucasian American; disparity reduction; effectiveness evaluation; efficacy evaluation; ethnic diversity; experience; group intervention; health care disparity; high risk; high risk population; improved; innovation; insight; mobile application; multidisciplinary; primary outcome; psychological distress; racial disparity; racial diversity; response; satisfaction; secondary outcome; shift work; treatment as usual; usability

Abstract - Research Project 3 TITLE: The effect of a needs-targeted intervention on racial disparities in unmet needs of patients and families in the intensive care unit The quality of palliative care is highly variable for the nearly 5 million annual ICU admissions. Many patients and families report unmet needs and poor communication and decision making; however, these reports are more common among African Americans and their families who are less satisfied with the quality of ICU care. Improving ICU care quality on a broad scale is challenging because of a limited palliative care workforce and ICU clinicians' difficulties in proactively identifying and addressing unmet needs among diverse patients and family members. To address these challenges to care delivery, we developed a mobile app that allows patients and families to self-report needs, receive information about palliative care, and get examples of questions that can improve understanding. Clinicians can visualize patient/family needs and decisional support on how to address them. In a series of pilot studies, we found that the need app is acceptable, feasible, and can reduce unmet palliative care needs in race/ethnically diverse populations. While our pilot data are promising, we need to definitively determine the effectiveness of the intervention and its effect on racial disparities in care. The proposed study will: (1) Optimize the app platform's usability in a racially diverse population, (2) Test the impact of app-augmented care vs usual care in a stepped-wedge trial on reducing racial disparities (African Americans and Whites) in unmet needs and satisfaction with care; and (3) Explore patient, family member, and clinician experiences using mixed methods to understand intervention mechanisms within unique case contexts. We hypothesize that compared to usual care, needs app-augmented care will reduce family members' unmet needs and psychological distress, increase the frequency of patients' receipt of goal concordant treatment, and reduce hospital length of stay in both whites and African Americans.

摘要 - 研究项目 3 标题：以需求为目标的干预措施对未满足需求的种族差异的影响 重症监护病房的患者和家属 每年 IC​​U 入院人数近 500 万人，姑息治疗的质量参差不齐。 许多患者和家属报告需求未得到满足以及沟通和决策不力； 然而，这些报告在非裔美国人及其家人中更为常见。 对 ICU 护理质量不太满意。广泛提高 ICU 护理质量是 由于姑息治疗人员有限且 ICU 临床医生在治疗方面存在困难，因此具有挑战性 主动识别和解决不同患者和家庭未满足的需求 成员。为了解决护理服务方面的这些挑战，我们开发了一款移动应用程序，允许 患者和家属自我报告需求，接收有关姑息治疗的信息，并获得 可以增进理解的问题示例。临床医生可以想象患者/家属 需求以及如何解决这些问题的决策支持。在一系列试点研究中，我们发现 该需求应用程序是可以接受的、可行的，并且可以减少未满足的姑息治疗需求 种族/民族多样化的人群。 虽然我们的试点数据很有希望，但我们需要明确确定该计划的有效性 干预及其对护理中种族差异的影响。拟议的研究将： (1) 优化 应用程序平台在种族多样化人群中的可用性，(2) 测试应用程序增强的影响 在减少种族差异的阶梯式楔形试验中，护理与常规护理的比较（非裔美国人 和白人）未满足的需求和对护理的满意度； (3) 探查患者、家庭成员、 和临床医生使用混合方法来了解干预机制的经验 独特的案例背景。我们假设与常规护理相比，需要应用程序增强 护理将减少家庭成员未满足的需求和心理困扰，增加 患者接受目标一致治疗的频率，并减少住院时间 白人和非裔美国人。