The influence of ward capacity strain on outcomes among survivors of acute respiratory failure
病房容量紧张对急性呼吸衰竭幸存者预后的影响
基本信息
- 批准号:10461743
- 负责人:
- 金额:$ 19.08万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2019
- 资助国家:美国
- 起止时间:2019-08-26 至 2024-07-31
- 项目状态:已结题
- 来源:
- 关键词:Acute respiratory failureAddressAdvocateAmericanAwardCaringCase ManagerCensusesClinicalComplementConsensusCritical CareCritical IllnessDevelopmentDisciplineDiscriminationElementsEnrollmentFaceFellowshipFundingFutureGeneral HospitalsGoalsGrantHospitalizationHospitalsImpaired cognitionImpaired healthIntensive Care UnitsInterventionIntervention TrialInterviewK-Series Research Career ProgramsKnowledgeLength of StayLong-Term SurvivorsLongitudinal cohort studyLungMaster of ScienceMeasurableMeasuresMechanical ventilationMechanicsMediatingMentorsMethodsModelingMorbidity - disease rateNational Heart, Lung, and Blood InstituteNursesOutcomePatient-Focused OutcomesPatientsPharmaceutical PreparationsPhysiciansPostdoctoral FellowPredictive AnalyticsProcessPublic HealthQualitative ResearchQuality of CareRandomized Controlled TrialsResearchResearch DesignResearch PersonnelResourcesRetrospective cohort studySamplingSocial WorkersStaff Work LoadStructureSurvivorsSystemTestingTimeTrainingWait TimeWeightWorkbasecare outcomescareerclinical epidemiologycohortdesigndeviantexperiencehealth related quality of lifehigh riskhospital readmissionimprovedimproved outcomeinnovationmortalitynovelprospectivepsychologicskillsstemsurvivorshiptherapy developmentward
项目摘要
Project Summary/Abstract
More than 1 million Americans survive acute respiratory failure (ARF) each year. These ARF survivors often
endure health-related quality of life, physical, psychological, and cognitive impairments in the months following
discharge. This growing public health and morbidity burden associated with ARF survivorship stems, in part,
from the fact that the robust evidence to guide best practices during mechanical ventilation is unmatched by
similar evidence to guide care after the intensive care unit (ICU) stay. Because 90% of ARF survivors transition
from ICUs to general hospital wards during their recoveries, the quality of ward-based care may strongly
influence patients’ outcomes. However, the methods needed to assess and improve ward systems practices
for ARF survivors do not exist. The candidate’s Master of Science in Clinical Epidemiology (MSCE) and F32
work defined the construct of “ward capacity strain,” which occurs when demand for clinical resources exceeds
availability. This work identified measures of ward patient volume and staff workload that contribute to ward
capacity strain, and demonstrated that increased strain was associated with prolonged ICU discharge wait
times and 30-day hospital readmissions among critical care survivors. This Career Development Award builds
from that work, and seeks to achieve three aims that, together, will promote the candidate’s long-term goal of
developing and testing strategies to improve ARF survivor outcomes by mitigating ward capacity strain and
other systems-level factors. Specifically, in this award the candidate seeks to measure associations of ward
capacity strain with (1) in-hospital outcomes and (2) post-hospitalization, patient-centered outcomes among
ARF survivors, and (3) identify care processes that mediate relationships between ward capacity strain and
patient outcomes, and ward-level systems practices that modify such relationships. To complete these aims
the candidate will perform a retrospective cohort study (Aim 1), a prospective longitudinal cohort study enrolling
176 ARF survivors (Aim 2), and a mixed-methods positive deviance study enrolling 50 ward-based clinicians
who care for survivors of ARF (Aim 3). The hands-on experience she will acquire in completing these three
studies using different methods will be complemented by carefully selected didactic coursework and structured
mentoring by senior investigators from multiple disciplines. This work will lead to pilot grants and an R21 to
support development of an intervention to mitigate the untoward effects of ward capacity strain on ARF
patients’ outcomes, and to an R01 to support a randomized controlled trial of this intervention. Completing this
research will build upon the candidate’s past training, which includes an MSCE obtained with NHLBI T32
support and an NHLBI F32-supported post-doctoral fellowship, and will provide her with the protected time and
experience to achieve her career goal of becoming a leading, independently-funded outcomes researcher
focused on leveraging systems-level practices to improve outcomes among survivors of ARF and other critical
illnesses.
项目摘要/摘要
每年有100多万美国人在急性呼吸衰竭(ARF)中存活下来。这些ARF幸存者经常
在接下来的几个月里忍受与健康相关的生活质量、身体、心理和认知障碍
出院。与ARF生存相关的日益增长的公共卫生和发病率负担在一定程度上源于,
事实上,指导机械通风最佳实践的强有力的证据是无与伦比的
类似的证据可以指导重症监护病房(ICU)留下来后的护理。因为90%的ARF幸存者过渡到
从ICU到普通医院病房,在他们康复期间,以病房为基础的护理质量可能会很高
影响患者的预后。然而,评估和改进病房系统实践所需的方法
因为ARF的幸存者是不存在的。候选人的临床流行病学理学硕士学位(MSCE)和F32
这项工作定义了“病房容量紧张”的结构,当临床资源需求超过时,就会发生这种情况
可用性。这项工作确定了对病房有贡献的病房病人数量和工作人员工作量的衡量标准。
容量应变,并证明应变增加与ICU出院等待时间延长有关
重症监护幸存者的住院次数和30天再入院时间。这个职业发展奖建立了
并寻求实现三个目标,这三个目标将共同促进候选人的长期目标
制定和测试策略,通过减轻病房容量压力和
其他系统层面的因素。具体地说,在这个奖项中,候选人试图衡量选民之间的联系
能力紧张与(1)住院结果和(2)住院后、以患者为中心的结果
ARF幸存者,以及(3)确定调解病房容量紧张和
患者结果,以及改变这种关系的病房级别的系统实践。为了实现这些目标
候选人将进行一项回顾队列研究(目标1),这是一项招募的前瞻性纵向队列研究
176名ARF幸存者(目标2),以及一项招募了50名病房临床医生的混合方法阳性偏差研究
他们照顾ARF的幸存者(目标3)。她在完成这三项任务时将获得的实践经验
使用不同方法的学习将由精心挑选的教学课程和结构化的教学工作来补充
由来自多个学科的高级调查人员提供指导。这项工作将导致试点赠款和R21,以
支持制定干预措施以减轻病房容量紧张对ARF的不良影响
患者的结果,并要求R01支持这项干预的随机对照试验。完成这项工作
研究将建立在候选人过去的培训基础上,其中包括通过NHLBI T32获得的MSCE
支持和NHLBI F32支持的博士后奖学金,并将为她提供受保护的时间和
实现她成为一名领先的、独立资助的成果研究人员的职业目标的经验
侧重于利用系统层面的做法来改善ARF和其他关键疾病幸存者的结果
疾病。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Rachel Kohn其他文献
Rachel Kohn的其他文献
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{{ truncateString('Rachel Kohn', 18)}}的其他基金
The influence of ward capacity strain on outcomes among survivors of acute respiratory failure
病房容量紧张对急性呼吸衰竭幸存者预后的影响
- 批准号:
10627125 - 财政年份:2019
- 资助金额:
$ 19.08万 - 项目类别:
The influence of ward capacity strain on outcomes among survivors of acute respiratory failure
病房容量紧张对急性呼吸衰竭幸存者预后的影响
- 批准号:
10684669 - 财政年份:2019
- 资助金额:
$ 19.08万 - 项目类别:
The influence of ward capacity strain on outcomes among survivors of acute respiratory failure
病房容量紧张对急性呼吸衰竭幸存者预后的影响
- 批准号:
10223428 - 财政年份:2019
- 资助金额:
$ 19.08万 - 项目类别:
The influence of ward capacity strain on outcomes among survivors of acute respiratory failure
病房容量紧张对急性呼吸衰竭幸存者预后的影响
- 批准号:
10000138 - 财政年份:2019
- 资助金额:
$ 19.08万 - 项目类别:
Defining measures of strain on hospital wards and their influence on survivors of acute respiratory failure
确定医院病房的紧张措施及其对急性呼吸衰竭幸存者的影响
- 批准号:
9395053 - 财政年份:2018
- 资助金额:
$ 19.08万 - 项目类别:
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