Longitudinal Patterns of Symptoms, Medication and Hospice Use in Nursing Home Residents Approaching End of Life

临终疗养院居民的症状、药物治疗和临终关怀服务的纵向模式

• 批准号: 10447119
• 负责人: JENNIFER TJIA
• 金额: $ 19.84万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10447119
• 关键词: Address; Admission activity; Adverse event; Affect; Aging; American; American Cancer Society; Analgesics; Antibiotics; Anticoagulants; Antidepressive Agents; Area; Attention; Benefits and Risks; Caring; Certification; Cessation of life; Characteristics; Clinical; Clinical Research; Clinical Sciences; Data; Data Reporting; Data Set; Dementia; Development; Discipline; Diuretics; Elderly; Enrollment; Explosion; Foundations; Frail Elderly; Fraud; Funding; Geography; Geriatrics; Goals; Growth; Health system; Hospice Care; Individual; Institutes; Interview; Length of Stay; Life; Life Expectancy; Link; Massachusetts; Measures; Medicare; Mentors; Mentorship; Methods; Modeling; Nursing Homes; Pain Measurement; Palliative Care; Palliative Medicine; Patients; Pattern; Performance; Pharmaceutical Preparations; Pharmacoepidemiology; Physician Executives; Play; Policies; Polypharmacy; Population; Prognosis; Provider; Qualitative Methods; Quality of life; Randomized Controlled Trials; Reporting; Research; Research Activity; Research Personnel; Research Support; Resources; Risk; Role; Schools; Science; Services; Site; Surveys; Symptoms; Training; Training Support; Translational Research; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; Universities; Vulnerable Populations; Work; base; care delivery; career; career development; clinical candidate; clinical center; clinically relevant; cost; data resource; design; end of life; evidence base; experience; hospice environment; hypnotic; improved; informant; innovation; medical schools; meetings; multidisciplinary; palliative; patient oriented research; payment; population based; population health; programs; quality of death; recruit; skills; symptomatic improvement; therapy development; tool

LONGITUDINAL PATTERNS OF SYMPTOMS, MEDICATION AND HOSPICE USE IN NURSING HOME RESIDENTS APPROACHING END OF LIFE The candidate’s long-term career objective is to make a sustained impact as a geriatric palliative care research leader by mentoring promising, multidisciplinary investigators in aging research. The candidate’s professional life has been dedicated to the conduct of patient-oriented research in geriatric pharmacoepidemiology for nursing home and hospice patients, focusing specifically on the topic of deprescribing. Establishing the evidence for the risks and benefits of prescribing and deprescribing decisions, and identifying which patients will receive the greatest benefit from deprescribing based on a shift from curative to symptom-oriented care, is challenging. Institutionalized frail older adults are a particularly vulnerable population because of their high burden of polypharmacy, risk of medication-related adverse events, limited life expectancy, and lack of randomized controlled trial data for medication efficacy. Training a multidisciplinary group of junior investigators is key to building the deprescribing evidence base. Studies are needed that can ultimately inform the design of tools that identify when nursing home residents are entering the final stages of their life and the development of interventions to optimize medication use when that happens. Thus, the objectives of this K24 are: 1. To enhance the candidate’s capacity to effectively mentor a multidisciplinary group of mentees in patient-oriented research, and 2. To expand the candidate’s clinical research program in geriatric palliative care and deprescribing in directions that create new and innovative opportunities for mentees, including qualitative methods for mixed-methods studies. This will be accomplished by: i. recruitment of promising mentees from varied disciplines committed to aging research, ii. individual mentorship of these trainees in their research activities and career development, and iii. didactic sessions and formal coursework for mentees. The candidate’s research brings together expertise in geriatrics and aging research, palliative medicine and hospice care, and pharmacoepidemiology. The candidate’s research program about nursing home residents and hospice enrollees grows out funding from the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Cancer Society and the Donoghue Foundation. These studies have contributed to the creation of rich data resources that will be used by mentees, including a nationwide dataset of all nursing home residents from 2011-2016 that links the Minimum Data Set 3.0 to Medicare Part D data, Certification and Survey Provider Enhanced Reporting data, Area Resource Files and Medicare Hospice Utilization Public Use Files. Resources supporting training, development, and execution of the proposed research include the University of Massachusetts Medical School’s (UMMS) Center for Clinical and Translational Science, UMMS’ Graduate School of Biomedical Sciences, UMMS’ Clinical and Population Health Research program, and the UMMS’ Quantitative Methods Core.

住院病人的症状、药物和医院使用的纵向模式 接近寿命终点的居民 候选人的长期职业目标是作为老年姑息治疗研究产生持续的影响 通过指导有前途的，多学科的研究人员在老龄化研究的领导者。候选人的专业 生命一直致力于老年药物流行病学中以患者为导向的研究， 护理之家和临终关怀患者，特别关注取消处方的主题。建立 处方和取消处方决定的风险和益处的证据，并确定哪些患者 将从基于从治疗性护理向以健康为导向的护理转变的取消处方中获得最大的好处， 挑战性机构化的体弱老年人是一个特别脆弱的人群，因为他们的高 多种药物的负担，药物相关不良事件的风险，预期寿命有限，缺乏 药物疗效的随机对照试验数据。培训一个多学科的初级调查员小组 是建立撤销处方证据库的关键需要进行研究，以最终为设计提供信息， 确定养老院居民何时进入生命的最后阶段以及 当这种情况发生时，采取干预措施来优化药物使用。因此，K24的目标是：1。到 提高候选人的能力，以有效地指导一个多学科小组的学员，以病人为导向， 研究，2。扩大候选人在老年姑息治疗方面的临床研究计划， 在为学员创造新的和创新的机会的方向，包括质量 混合方法研究。这将通过以下方式实现：招聘有前途的学员， 致力于老龄化研究的各种学科，二。为这些学员提供研究方面的个别指导 活动和职业发展，以及iii.为学员举办教学会议和正式课程。的 候选人的研究汇集了老年医学和老龄化研究，姑息医学和 临终关怀和药物流行病学。候选人关于养老院居民的研究计划 而临终关怀的注册者来自美国国立卫生研究院，医疗保健机构， 研究和质量，美国癌症协会和多诺霍基金会。这些研究 为创建将由学员使用的丰富数据资源做出了贡献，包括全国性的数据集 从2011年到2016年，所有养老院居民将最小数据集3.0与医疗保险D部分数据联系起来， 认证和调查提供商增强报告数据、地区资源文件和医疗保险临终关怀 利用公共使用文件。支持培训、开发和执行拟议 研究包括马萨诸塞州大学医学院（UMMS）临床和医学中心 转化科学，UMMS的生物医学科学研究生院，UMMS的临床和人口 健康研究计划，和UMMS的定量方法核心。