Emergency General Surgery Treatment of Older Multimorbid Patients

老年多病患者的紧急普通外科治疗

• 批准号: 10315304
• 负责人: Claire Rosen
• 金额: $ 7.31万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-23 至 2023-08-22
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10315304
• 关键词: Academic Medical Centers; Academy; Address; Adherence; Admission activity; Adult; Advocate; Affordable Care Act; Age; American; Bioethics; Cardiology; Caring; Cessation of life; Client satisfaction; Clinical; Clinical Practice Guideline; Communication; Communication Tools; Complex; Complication; Consultations; Counseling; Data; Data Analyses; Decision Making; Degree program; Destinations; Education; Elderly; Emergency Situation; Emergency department visit; Emotional; Faculty; Family; Focus Groups; Foundations; Future; Goals; Grant; Health; Health Care Costs; Health Personnel; Health Policy; Health Resources; Healthcare; Hospitalization; International; Knowledge; Laparotomy; Life; Master of Science; Medical; Medical Ethics; Medicare claim; Mentors; Methods; Operative Surgical Procedures; Outcome; Patient Care; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pennsylvania; Physicians; Population; Positioning Attribute; Procedures; Provider; Public Health; Qualifying; Quality of Care; Replicating Effective Programs; Research; Research Ethics; Research Personnel; Research Training; Resources; Risk; Science; Scientist; Structure; Surgeon; Techniques; Time; Training; United States; Universities; Work; base; burden of illness; cohort; college; comorbidity; end of life; health care service utilization; implementation framework; implementation science; improved; instrument; mortality; multidisciplinary; multiple chronic conditions; novel; older patient; operation; overtreatment; patient expectation; patient oriented; surgery outcome; tool; treatment choice; treatment planning; wasting

PROPOSAL SUMMARY/ABSTRACT Each year in the United States, there are three million emergency general surgery hospital admissions, with 30% of these patients requiring surgical intervention. Multimorbid, older patients are a complex population encompassing immense health resource utilization, but outcomes data regarding the impact of multimorbidity on older emergency general surgery patients are lacking. This limits surgeon ability to set realistic expectations for patients, which is key to enacting goal-concordant care. Patient-centered care is a national standard under the Patient Protection and Affordable Care Act and has been shown to improve health outcomes and patient satisfaction. The “Best case/Worst case” communication tool is a validated instrument to facilitate treatment choice by using scenario planning to improve patient understanding of realistic outcomes. The impact of data on the use of this tool, however, has not yet been characterized. This project will (1) define the impact of multimorbidity on outcomes for older patients requiring emergency general surgery operations using comprehensive nationwide data analysis, (2) characterize the barriers and facilitators of integrating novel data into the Best case/Worst case communication tool through focus groups and complex qualitative analysis, and (3) create an education tool kit to integrate data into using the Best case/Worst case tool using implementation science. Beyond supporting the above research, the training goal of this project is to further Dr. Claire Rosen’s training in mixed methods biomedical ethics research with a focus on patient communication, and to prepare her to become an independent investigator. The above grant will support the education of Dr. Rosen, who will pursue a Master of Science in Medical Ethics through the University of Pennsylvania Department of Medical Ethics and Health Policy. This degree program has a primary goal of training physician-scientists aspiring to empirically oriented bioethics faculty positions in academic medical centers through structured content and scientific methods coursework and mentored research. This project fills a knowledge gap regarding the outcomes of multimorbid older emergency general surgery patients and uses qualitative analysis and implementation science to improve patient-centered care and communication, striving towards national demands for higher quality care. The work will be a major step in enabling Dr. Rosen to become an independent investigator, expert in biomedical ethics, and advocate for older, multimorbid emergency general surgery patients.

建议书摘要/摘要 在美国，每年有300万急诊普外科医院入院，占30% 这些需要手术治疗的患者中。多发病、老年患者是一个复杂的人群 包括巨大的卫生资源利用，但关于多发病影响的结果数据 年纪较大的急诊普外科患者很少。这限制了外科医生设定现实的期望的能力 患者，这是制定目标一致护理的关键。以病人为中心的护理是国家医疗服务体系的国家标准 《患者保护和平价医疗法案》，已被证明可以改善健康状况和患者 满足感。“最好情况/最坏情况”沟通工具是一种有效的工具，有助于治疗 通过使用情景规划进行选择，以提高患者对现实结果的理解。数据对以下方面的影响 然而，这个工具的使用还没有被描述出来。该项目将(1)定义 多发病对需要急诊普外科手术的老年患者预后的影响 全面的全国性数据分析，(2)描述整合新数据的障碍和促进者 通过焦点小组和复杂的定性分析，成为最佳/最坏情况沟通工具，以及 (3)创建教育工具包，通过实施将数据集成到最佳/最坏情况工具中 科学。除了支持上述研究外，该项目的培训目标是进一步发展Claire Rosen博士的 混合方法生物医学伦理学研究的培训，重点是患者沟通，并为她做好准备 成为一名独立调查员。上述赠款将支持罗森博士的教育，他将继续 宾夕法尼亚大学医学伦理学系医学伦理学硕士 卫生政策。该学位课程的主要目标是培养有志于经验主义的内科科学家。 以结构化内容和科学性为导向的学术医学中心生物伦理学教师职位 方法课程作业和辅导性研究。该项目填补了关于以下成果的知识空白 多病种老年急诊普外科患者，运用定性分析和实施学 加强以患者为中心的关怀和沟通，努力实现国家对更高质量护理的需求。 这项工作将是使罗森博士成为一名独立研究员、生物医学专家的重要一步 道德规范，倡导老年、多发病的急诊普外科患者。