Hospital adaptation and resiliency for infected and uninfected patients during respiratory viral surge events: from seasonal influenza to COVID-19

呼吸道病毒激增事件期间受感染和未受感染患者的医院适应和弹性：从季节性流感到 COVID-19

• 批准号: 10348997
• 负责人: George L Anesi
• 金额: $ 16.43万
• 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: 2021-12-15 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10348997
• 关键词: Accounting; Acute; Acute respiratory failure; Adherence; Administrator; Adoption; Affect; Applications Grants; Bioethics; COVID-19; COVID-19 pandemic; COVID-19 patient; Career Choice; Caring; Characteristics; Chronic Obstructive Pulmonary Disease; Clinical; Congestive Heart Failure; Coronavirus; Cost Effectiveness Analysis; Critical Care; Critical Illness; Data; Diagnosis; Electronic Health Record; Epidemic; Event; Face; Family Caregiver; Future; Goals; Grant; Healthcare; Hospitalization; Hospitals; Hypersensitivity; Individual; Infection; Influenza; Influenza A Virus, H1N1 Subtype; Intervention; Interview; Knowledge; Leadership; Lung; Master' s Degree; Measures; Medical; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Middle East Respiratory Syndrome; Outcome; Outcome Measure; Patient-Focused Outcomes; Patients; Pennsylvania; Perception; Plants; Pneumonia; Positioning Attribute; Process; Public Health; Publications; Qualitative Research; Quality of Care; Readiness; Research; Research Methodology; Research Personnel; Research Training; Retrospective cohort study; Risk; Seasons; Sepsis; Services; Severe Acute Respiratory Syndrome; Statistical Models; Structure; Testing; Time; Training; Universities; Viral; Virus; Work; base; biomedical referral center; care delivery; care outcomes; career; career development; career preparation; clinical epidemiology; combat; cost; discrete data; evidence base; experience; falls; implementation science; improved; indexing; innovation; instructor; interest; medical schools; novel; operation; pandemic disease; preservation; resilience; respiratory; response; seasonal influenza; supplemental oxygen; symposium

Project Summary / Abstract My long-term career goal is to become a leading independent investigator developing and evaluating surveillance, preparedness, and operations response strategies to combat the public health burdens from respiratory viral surge events. Respiratory viral surge events, in which hospitals face capacity strain from an influx of infected patients, range from annual respiratory viral seasons dominated by seasonal influenza to rarer and more severe epidemics such as due to novel influenzas (e.g., H1N1) and coronaviruses (e.g., COVID-19, SARS, MERS). Optimizing outcomes for both infected patients and uninfected patients admitted during viral surges (i.e., “bystander patients”), requires that hospitals display: (1) adaptation—the ability to improve care and outcomes for infected patients by implementing new care processes based on accumulated experience, and (2) resiliency—the ability to continue to deliver high quality care to uninfected patients despite the presence of a surge event. However, it is unknown what enables hospitals to display adaptation and resiliency, thereby threatening care quality for all patients during viral surges. I am an Instructor of Medicine in the Division of Pulmonary, Allergy, and Critical Care at the University of Pennsylvania Perelman School of Medicine. My preparations for this career path include masters degrees in clinical epidemiology and biomedical ethics, mentored research training resulting in high-impact first-author publications serving as preliminary data, national invited talks at universities and academic conferences, and clinical work as a pulmonologist and medical intensivist at a major academic referral center. This grant application seeks to combine my and my mentorship team’s experience in defining and studying healthcare capacity strain with purposefully selected career development activities to achieve my complementary training and research goals including methodologic training in advanced statistical modeling, qualitative research methods, implementation science, and cost-effectiveness analysis. The specific aims of this grant are to: (1) Quantify adaptation by determining how hospitals’ cumulative seasonal experiences with influenza affect processes of care and clinical outcomes among high acuity patients with influenza. (2) Measure resiliency by determining how hospitals’ daily capacity strain and cumulative experience during respiratory viral surges affect processes of care and clinical outcomes among bystander patients (i.e., without infection) at risk for acute respiratory failure. (3) Identify organizational characteristics that may influence how hospitals achieve, or struggle to achieve, adaptation and resiliency in the face of a respiratory viral surge event. At the end of the proposed K23 award, I expect to understand how care delivery and outcomes change over the course of a respiratory viral surge event and what organizational factors may account for observed differences in hospital adaptation and resiliency. These findings will have substantial positive impact by facilitating testing organizational interventions to improve hospital adaptation and resiliency, which will be the focus of my initial R01 applications at the conclusion of the K23 award.

项目概要/摘要 我的长期职业目标是成为一名领先的独立调查员，开发和评估 监测、准备和行动响应战略，以减轻公共卫生负担 呼吸道病毒激增事件。呼吸道病毒激增事件，医院面临来自病毒的能力紧张 感染患者的涌入，范围从每年以季节性流感为主的呼吸道病毒季节到 更罕见和更严重的流行病，例如由新型流感（例如 H1N1）和冠状病毒（例如 COVID-19、SARS、MERS）。优化收治的感染患者和未感染患者的治疗结果 在病毒激增期间（即“旁观者患者”），要求医院表现出：（1）适应能力——有能力 通过实施基于累积数据的新护理流程，改善感染患者的护理和结果 经验，以及 (2) 弹性——尽管如此，仍然能够继续为未感染患者提供高质量护理的能力 浪涌事件的存在。然而，尚不清楚是什么使医院能够表现出适应和 弹性，从而威胁到病毒激增期间所有患者的护理质量。我是一名医学讲师 宾夕法尼亚大学佩雷​​尔曼学院肺部、过敏和重症监护科 药品。我为这条职业道路做的准备包括临床流行病学和生物医学硕士学位 道德规范，指导研究培训，产生具有高影响力的第一作者出版物作为初步数据， 在大学和学术会议上做全国特邀演讲，以及作为肺科医生的临床工作和 一家主要学术转诊中心的医疗重症医生。该拨款申请旨在将我和我的 指导团队在定义和研究医疗保健能力压力方面的经验，并有针对性地选择 职业发展活动以实现我的补充培训和研究目标，包括 高级统计模型、定性研究方法、实施科学方面的方法培训， 和成本效益分析。这笔赠款的具体目标是： (1) 通过确定来量化适应 医院累积的季节性流感经验如何影响护理过程和临床结果 严重程度高的流感患者中。 (2) 通过确定医院的日常容量来衡量弹性 呼吸道病毒激增期间的应变和累积经验会影响护理过程和临床结果 有急性呼吸衰竭风险的旁观患者（即未感染）。 (3) 确定组织机构 可能影响医院如何实现或努力实现适应和弹性的特征 面对呼吸道病毒激增事件。在拟议的 K23 奖项结束时，我希望了解如何 护理服务和结果在呼吸道病毒激增事件过程中发生变化，以及组织应采取哪些措施 一些因素可以解释观察到的医院适应和弹性的差异。这些发现将有 通过促进测试组织干预措施以提高医院适应能力和 弹性，这将是我在 K23 奖项结束时最初的 R01 申请的重点。