Project-003

项目-003

• 批准号: 10450785
• 负责人: Dawn Dowding
• 金额: $ 16.14万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-08 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10450785
• 关键词: Acculturation; Address; Adult; Age; Area; Behavioral Model; Biometry; Caring; Characteristics; Chronic; Common Data Element; Communication; Compassion; Consultations; Coupled; Ecology; Effectiveness; End stage renal failure; Ensure; Environment; Ethnic Origin; Face; Foundations; Funding; Future; Geographic Locations; Health; Health Services; Health behavior; Hospitalization; Infrastructure; Interdisciplinary Study; Knowledge; Life; Location; Logic; Medical; Methods; Modeling; National Institute of Nursing Research; New York; Nurses; Nursing Homes; Nursing Services; Outcome; Output; Palliative Care; Patients; Pattern; Pilot Projects; Population; Principal Investigator; Procedures; Process; Quality of life; Race; Research; Research Methodology; Research Personnel; Resource Sharing; Risk; School Nursing; Science; Scientist; Self Management; Services; Sex Orientation; Socioeconomic Status; Training; Universities; Visiting Nurse; Vulnerable Populations; acute care; base; biobehavior; care coordination; formative assessment; health care service utilization; health care settings; high risk; hospice environment; improved; innovation; meetings; multilevel analysis; multiple chronic conditions; patient population; preference; programs; satisfaction; skills; symptom management; urban dwelling

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”.

多种慢性病（MCC）定义为两种或多种同时发生的慢性病， 脆弱的成年患者，如住在疗养院或患有终末期肾病的患者。弱势 成年MCC患者的健康状况较差，对各类卫生服务的利用率较高 与那些没有慢性病的人相比，他们更容易受到不适当的 和/或繁重的服务（例如，程序，治疗和住院治疗），不符合他们的 喜好医学上的复杂性本身并不能解释这些差异;在许多方面，问题各不相同。 特征，包括种族/民族，文化适应和居住地点。此外，虽然大多数缓解 目前提供的护理是在急性护理，建议跨学科姑息治疗开始早期， 任何严重的疾病，并提供整个连续的卫生保健环境。存在知识差距 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;必须解决这些知识差距，以提供有效的创新跨学科护理 在多个卫生保健环境中为弱势成人MCC患者提供模型，以确保他们获得 适当的照顾是符合他们的喜好。为了弥补这些差距，探索性的 P20改善弱势MCC成人姑息治疗中心（CIPC）将：1）制定一个 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MCC弱势成年人在医疗保健环境中进行生物行为，姑息治疗研究; 2)制定新的生物行为计划，针对MCC脆弱成人的姑息治疗研究， 提高参与研究者的跨学科知识和技能， 生物行为，姑息治疗的研究方法，在整个卫生保健设置为弱势成人与MCC和 向相关利益攸关方传播新知识; 4）评估中心的投入、产出， 持续和每年的成果，并根据需要完善进程。CIPC是独一无二的， 发展这方面的研究能力。哥伦比亚大学护理学院与 纽约的探访护士服务增加了试点项目调查人员进入脆弱城市的机会， 成年人患有MCC。丰富计划活动，这是由领先的跨学科 姑息治疗临床医生，沿着在试点管理核心的支持下， (e.g., MCC成人生物行为研究和生物统计学的混合方法）和专家咨询， 姑息治疗研究合作社，提供了一个良好的基础，在最佳实践的生物行为， 姑息治疗研究这一基础加上强大的研究环境和强大的 行政核心增加了CIPC实现其重要目标的可能性， 国家康复研究所的战略主题是“临终关怀和姑息治疗：临终关怀的科学”。