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.

项目摘要 /摘要 我的长期职业目标是成为发展和评估的领先的独立研究者 监视，准备和操作响应策略，以与 呼吸病毒激增事件。呼吸道病毒激增事件，医院面临的容量应变 受感染患者的涌入，范围从以季节性影响为主的年度呼吸道病毒季节到 由于新的影响（例如H1N1）和冠状病毒（例如，例如， COVID-19，SARS，MERS）。优化受感染患者和未感染患者的预后 在病毒激增（即“旁观者患者”）期间，需要医院显示：（1）适应 - 通过基于累积的新护理过程来改善受感染患者的护理和结果 经验和（2）弹性 - 能够继续向未感染患者目的地提供高质量护理的能力 激增事件的存在。但是，尚不清楚什么使医院能够显示适应和 弹性，从而威胁到病毒促进期间所有患者的护理质量。我是医学教练 宾夕法尼亚大学Perelman School的肺部，过敏和重症监护系 药品。我对这一职业道路的准备包括临床流行病学和生物医学的硕士学位 伦理学，指导的研究培训导致了高影响力的第一名出版物，作为初步数据， 国家邀请大学和学术会议的会谈，以及作为肺科医生和 主要的学术转诊中心的医学强化主义者。该赠款申请旨在将我和我的 Menorship Team在定义和研究医疗保健能力应变方面的经验 职业发展活动以实现我的完整培训和研究目标 高级统计建模，定性研究方法，实施科学中的方法学培训， 和成本效益分析。这笔赠款的具体目的是：（1）通过确定适应 医院的累积季节性经历如何影响护理和临床结果的过程 在具有影响力的高敏锐患者中。 （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和临床结果的过程 在旁观者患者（即没有感染）中，有急性呼吸衰竭的风险。 （3）确定组织 可能会影响医院实现或努力实现，适应和弹性的特征 呼吸道病毒激增事件的面孔。在拟议的K23奖项结束时，我希望了解如何 在呼吸道病毒激增事件的过程中，护理交付和结果发生了变化 因素可能是观察到的医院适应和弹性差异。这些发现将有 通过促进测试组织干预措施以改善医院适应和 弹性，这将是我最初的R01申请的重点，这是K23奖的结论。