Preventing avoidable deaths from pneumonia by improving use of intensive care

项目摘要/摘要 候选人的长期职业目标：成为一名独立的调查员和决策科学家 改善重症监护病房(ICU)的临床决策。 有待解决的临床问题：每年有1万名美国人死于肺炎，但如果他们 曾在重症监护室接受治疗。这项提议的总体假设是，有一些可定义的特征 可以从ICU护理中受益但没有得到护理的患者，这些特征通常不会 被纳入到围绕ICU护理的医生决策的认知模型中，即使当这些 模型是准确的，医院因素阻止医生提供潜在的挽救生命的ICU护理。 候选人背景和成就：托马斯·瓦利博士是一名肺和重症监护讲师 密歇根大学医学院。他获得了医疗保健研究的硕士学位。到目前为止，他 发表了15篇论文，包括9篇同行评议的原创研究手稿，其中他是第一作者 在5上，包括在JAMA中的1。他获得了两项试点拨款和一项NHLBI贷款偿还奖。他的部门 对他的坚定承诺包括于2018年6月1日任命为助理教授，无论 这项提议的结果是，启动一揽子计划，其中包括25万美元的可自由支配的研究基金。 职业发展计划：为了实现他的目标，瓦利博士建议在以下领域开发新的专业知识 通过正式的课程作业和指导性研究学习决策科学。他的主要导师是西奥多 他指导了5名临床医生科学家获得K奖，其中2人已经获得了R01 或同等的奖项。他是由人口健康科学主席Angela Fagerlin共同指导的， 犹他州的决策科学家，以及密歇根的ICU组织和政策专家科林·库克。 目标：利用对现有数据的二次分析和主要数据收集，他将1)开发和 验证预测模型，以确定哪些肺炎患者应该进入ICU，但通常是 不是；2)经验性地确定医生关于ICU入院的关键决策模型；3)描述 组织一级的障碍和促进者，以改进ICU入院做法。 来自AIMS的交付成果：提议的AIMS将导致4篇新论文，并为山谷博士撰写1篇R21 和1个R01提案。R21将开发和试验一种工具，以识别哪些肺炎患者应该 接受ICU治疗。R01将在一项集群随机试验中测试这一工具，以改善ICU对肺炎的使用。

PROJECT SUMMARY/ABSTRACT Candidate’s Long-Term Career Goal: To become an independent investigator and decision scientist seeking to improve clinical decision-making in the intensive care unit (ICU). Clinical Problem to be Addressed: Each year, 10,000 Americans die from pneumonia, yet might not if they had received care in the ICU. This proposal’s overall hypothesis is that there are definable characteristics of patients who could benefit from ICU care but do not receive it, that those characteristics are often not incorporated into cognitive models of physician decision-making around ICU care, and that even when those models are accurate, hospital factors prevent physicians from providing potentially life-saving ICU care. Candidate’s Background and Achievements: Dr. Thomas Valley is a Lecturer in Pulmonary and Critical Care Medicine at the University of Michigan. He has earned a Master’s degree in healthcare research. To date, he has published 15 papers, including 9 original peer-reviewed research manuscripts, of which he was first author on 5, including 1 in JAMA. He has won 2 pilot grants and an NHLBI Loan Repayment award. His department’s strong commitment to him includes an appointment as Assistant Professor on June 1, 2018, regardless of the outcome of this proposal, with a start-up package including $250,000 of discretionary research funds. Career Development Plan: In order to achieve his goals, Dr. Valley proposes to develop new expertise in decision science through formal coursework and mentored research. His primary mentor is Theodore Iwashyna at Michigan, who has mentored 5 clinician-scientists on K awards, of whom 2 have already won R01 or equivalent awards. He is co-mentored by Angela Fagerlin, Chair of Population Health Sciences and a decision scientist at Utah, and Colin Cooke, an expert in ICU organization and policy at Michigan. Aims: Using both secondary analysis of existing data and primary data collection, he will 1) develop and validate a prediction model to identify patients with pneumonia who should be admitted to the ICU, but often are not; 2) empirically identify key decision-making models of physicians about ICU admission; and 3) characterize barriers and facilitators at the organizational-level to improving ICU admission practices. Deliverables from Aims: The proposed Aims will lead to 4 new papers and prepare Dr. Valley to write 1 R21 and 1 R01 proposal. The R21 will develop and pilot a tool to identify patients with pneumonia who should receive ICU care. The R01 will test this tool in a cluster randomized trial to improve ICU use for pneumonia.