Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC)

多发性慢性疾病(MCC)，定义为两种或两种以上共同发生的慢性疾病，经常发生在 脆弱的成人患者，如那些住在疗养院或患有终末期肾脏疾病的人。易受攻击 患有MCC的成人人群的健康状况较差，所有类型的健康服务的利用率较高 与那些没有慢性病的人相比，他们接受不适当治疗的风险更高 和/或负担沉重的服务(例如，程序、治疗和住院)与其 偏好。医学的复杂性本身并不能解释这些差异；这些问题在许多方面都有所不同 特征包括种族/民族、文化适应和居住地点。此外，虽然最姑息的是 目前在急性护理中提供护理，建议及早开始跨学科姑息治疗 任何严重疾病，并可在整个卫生保健环境中传播。存在着知识差距 在关键的姑息治疗领域，包括如何最好地支持症状管理、沟通和护理 协调；必须弥补这些知识差距，以提供有效的创新跨学科护理 为易受感染的成年MCC患者提供多种医疗保健模式，以确保他们获得 与他们的喜好一致的适当护理。为了解决这些差距，探索性的 P20改善对患有MCC的弱势成年人的姑息护理中心(CIPC)将：1)制定 支持跨学科研究人员发展成为跨学科团队的可持续基础设施 为患有MCC的脆弱成年人进行生物行为、姑息治疗研究； 2)开发针对患有MCC的脆弱成年人的生物行为、姑息治疗研究的新计划，由 护士科学家；3)提高参与研究人员跨学科的知识和技能， 针对患有MCC和MCC的弱势成年人的跨卫生保健环境的生物行为、姑息护理研究方法 向相关利益攸关方传播新知识；以及4)评估中心的投入、产出和 在持续和每年的基础上取得成果，并根据需要改进进程。CIPC正准备独一无二地 发展这一领域的研究能力。哥伦比亚大学护理学院与 纽约探访护士服务增加了试点项目调查人员接触脆弱城市的机会 患有MCC的成年居民。丰富计划活动，由领先的跨学科提供信息 姑息治疗临床医生，以及具有丰富科学专业知识的试点行政核心的支持 (例如，MCC和生物统计学的成人生物行为研究的混合方法)和专家咨询 姑息治疗研究合作社为生物行为、 姑息治疗研究。这一基础加上稳健的研究环境和强大的 行政核心增加了CIPC实现其与以下各项一致的重要目标的可能性 NINR的战略主题是“生命的终结和姑息治疗：慈悲的科学”。

Multiple chronic conditions (MCC), defined as two or more co-occurring chronic conditions, occur frequently in vulnerable adult patients such as those living in nursing homes or with end-stage renal disease. Vulnerable adult populations with MCC have worse health outcomes and higher utilization of all types of health services compared to those who do not have chronic conditions, and they are at higher risk of receiving inappropriate and/or burdensome services (e.g., procedures, treatments, and hospitalizations) that are inconsistent with their preferences. Medical complexity alone does not explain these differences; the issues vary on many characteristics including race/ethnicity, acculturation, and living location. Furthermore, while most palliative care is currently provided in acute care, it is recommended that interdisciplinary palliative care begin early for any serious illness and be delivered across the continuum of health care settings. There are knowledge gaps in key palliative care areas including how best to support symptom management, communication, and care coordination; these knowledge gaps must be addressed to provide effective innovative interdisciplinary care models in multiple health care settings for vulnerable adult patients with MCC to ensure they receive appropriate care that is consistent with their preference . To address these gaps, the aims of the exploratory P20 Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC) are to: 1) Develop a sustainable infrastructure that supports interdisciplinary researchers to develop into transdisciplinary teams that conduct biobehavioral, palliative care research across health care settings for vulnerable adults with MCC; 2) Develop new programs of biobehavioral, palliative care research for vulnerable adults with MCC led by nurse scientists; 3) Enhance the knowledge and skills of participating investigators on transdisciplinary, biobehavioral, palliative care research methods across health care settings for vulnerable adults with MCC and disseminate new knowledge to relevant stakeholders; and 4) Evaluate the Center's inputs, outputs, and outcomes on an ongoing and annual basis and refine processes as needed. The CIPC is uniquely poised to develop research capacity in this area. The partnership between Columbia University School of Nursing and the Visiting Nurse Service of New York increases access of pilot project investigators to vulnerable urban dwelling adults with MCC. The Enrichment Plan activities, which are informed by leading interdisciplinary palliative care clinicians, along with support from the Pilot Administrative Core with vast scientific expertise (e.g., mixed methods biobehavioral research in adults with MCC and biostatistics) and expert consultation with the Palliative Care Research Cooperative, provide an excellent foundation in best practices for biobehavioral, palliative care research. This foundation coupled with the robust research environment and strong Administrative Core increases the likelihood of the CIPC meeting its important aims which are consistent with NINR's strategic theme “End-of Life and Palliative Care: The Science of Compassion”.