Improving patient- and family-centered outcomes and value of care for patients with chronic illness who develop acute respiratory failure

项目摘要/摘要 候选人：这个K23奖项将为Khandelwal博士提供一个机会来实现她的长期目标 成为一名独立资助的内科科学家，致力于改善以患者和家庭为中心的状况 急性呼吸衰竭(ARF)患者及其家属的结局。通过这一提议， Khandelwal博士将实现她的近期目标：1)评估患者--以及 家庭报告的结果，使用定性方法为发展和评估提供信息 干预措施以及先进的多水平统计方法和临床试验方面的培训；以及2)试点数据和 成功申请R级拨款的技能，包括临床试验和纵向队列研究。这些 目标将通过职业发展计划来实现，该计划包含正式的课程工作，熟练的 指导和保护时间，以便在卓越的环境中获得研究经验。 研究：在这项以患者为导向的研究提案中，坎德尔瓦尔博士将确定ARF患者和 预后不良的风险最大的慢性病(心理困扰、功能障碍、 财政压力)，以及对以下方面最有帮助的支持性和姑息性干预类型 改善这些结果。为了实现这一点，她将：1)确定贫困患者和家庭的预测因素 结果，包括慢性病的数量和类型、虚弱程度和以前的医疗保健使用情况；2) 确定医院和ICU使用率和成本较高的预测因素；以及3)探索患者、家庭和临床医生 对他们认为的支持性和姑息性干预的类型、时机和可行性的看法 会改善这些结果。到目前为止，改善患者或家庭结果的努力一直是 这一结果令人失望，并表明有必要针对特定人群和特定需求进行干预。 这些目标的发现将为ARF患者带来创新的干预措施，这些患者面临着最大的 糟糕的结果以及潜在的负担和昂贵的医疗保健。通过有效地针对支持性和姑息治疗 资源提供给那些需要并可能受益最多的人，这项研究有可能改善价值驱动的护理 这些脆弱的人群。 环境：华盛顿大学(UW)是Khandelwal博士进行研究培训的理想场所。 威斯康星大学是一家杰出的生物医学研究机构，致力于推动学术 有前途的调查员的职业生涯。威斯康星州大学麻醉学和疼痛医学系 认可其对早期职业医生科学家在发展必要技能方面的支持，以实现 学业上的成功。除了她的部门内提供的资源外，坎德尔沃博士还将拥有 康比亚大学卓越姑息治疗中心的全力支持(由她的主要导师指导)和 将获得临床研究和生物统计学支持，通过华盛顿大学公共卫生学院和 翻译健康科学研究所(威斯康星大学临床和翻译科学奖项目)。

PROJECT SUMMARY/ABSTRACT Candidate: This K23 award will provide an opportunity for Dr. Khandelwal to achieve her long-term goal of being an independently funded physician scientist with a focus on improving patient- and family-centered outcomes for patients with acute respiratory failure (ARF) and their family members. Through this proposal, Dr. Khandelwal will achieve her immediate goals of acquiring: 1) expertise in the evaluation of patient-and family-reported outcomes, use of qualitative methods to inform the development and assessment of interventions, and training in advanced multi-level statistical methods and clinical trials; and 2) pilot data and skills to successfully apply for R level grants that include clinical trials and longitudinal cohort studies. These objectives will be achieved through a career development plan that incorporates formal coursework, skilled mentoring, and protected time to gain research experience in an outstanding environment. Research: In this patient-oriented research proposal, Dr. Khandelwal will identify patients with ARF and chronic illness who are at greatest risk for poor outcomes (psychological distress, functional impairment, financial stress), and the types of supportive and palliative interventions that would be most helpful in improving these outcomes. To accomplish this, she will: 1) identify predictors of poor patient and family outcomes, including number and type of chronic conditions, measures of frailty, and prior healthcare use; 2) identify predictors of high hospital and ICU utilization and costs; and 3) explore patient, family, and clinician perspectives on the types, timing, and feasibility of supportive and palliative interventions that they believe would improve these outcomes. To date, attempts to improve patient or family outcomes have been disappointing and suggest the need for interventions targeted to specific populations and specific needs. Findings from these aims will result in innovative interventions for patients with ARF who are at greatest risk for poor outcomes and potentially burdensome, costly care. By efficiently targeting supportive and palliative care resources to those who need and may benefit most, this study has the potential to improve value-driven care to this vulnerable population. Environment: The University of Washington (UW) is an ideal setting for Dr. Khandelwal's research training. UW is an outstanding biomedical research institution with a strong commitment to promoting the academic careers of promising investigators. The UW Department of Anesthesiology & Pain Medicine is widely recognized for its support of early career physician scientists in development of the skills necessary to achieve academic success. In addition to the resources provided within her Department, Dr. Khandelwal will also have the full support of the Cambia Palliative Care Center of Excellence at UW (directed by her primary mentor) and will have access to clinical research and biostatistical support through the UW School of Public Health and the Institute of Translational Health Sciences (the Clinical and Translational Science Award program at UW).