Identifying palliative care needs among hospitalized patients with chronic obstructive pulmonary disease

项目总结 数百万患有慢性阻塞性肺疾病的美国人经历着负担沉重的症状，生活质量下降，以及令人不快的 临终关怀。人们普遍主张增加对这一弱势群体的姑息治疗，以改善这些 以患者为中心的重要结果。然而，慢性阻塞性肺疾病患者很少得到姑息治疗，部分原因是 难以确定哪些患者有未满足的姑息治疗需求和姑息治疗劳动力短缺。 这项拟议的研究的核心目标是解决改善患者姑息治疗的国家优先事项 通过开发一种高效、创新和以患者为中心的方法来识别未满足的患者，从而与COPD合作 姑息治疗的需要。具体地说，候选人寻求(1)评估COPD患者以确定他们的 姑息治疗需求；(2)开发和验证基于电子健康记录的分类模型 姑息护理需求领域；以及(3)评估未得到满足的概率与 姑息治疗需求和以患者为中心的临床结果。这项研究将涉及面对面的交叉- 432例COPD各期住院患者的横断面调查参与者将完成经过验证的 调查，以了解各种各样的姑息治疗需求，并将辅以专家图表审查 确定在临床相关和可操作的三个领域中的任何一个领域有需求的患者。这些案件将是 用作患者报告的参考标准，用于开发和验证特定领域 电子健康中利用自然语言处理非结构化临床文本的分类模型 记录和机器学习方法。最后，一项大型的多中心回溯性队列研究将评估 未得到满足的姑息治疗需求的不同概率与几个临床病例的关系 结果对患者、护理人员和医院都很重要。这将使得能够识别以下阈值 未满足需求的概率，超过该概率，慢性阻塞性肺疾病患者不良临床结局的风险增加。 然后，这些患者将成为未来试验的目标，测试干预措施以改善这些 结果。完成这项研究将建立在候选人过去的培训基础上，其中包括硕士学位 在NHLBI T32支持下获得的卫生政策研究，F32支持的博士后奖学金，以及 国家姑息治疗研究中心颁发的职业发展奖，并将提供经验， 教育和指导，使候选人能够成为一名完全独立的调查员。候选人的 严谨的培训计划，专注于获得多站点前瞻性研究的高级技能，以患者为中心 结果研究和先进的生物信息学方法将使她能够提交成功的R01或PCORI 测试干预措施的应用程序直接由这项工作的结果通知。候选人的主要导师， 合作者和顾问将确保遵守建议的时间表和目标，并提供支持性 为她发展专注于提高理解和理解的独立研究事业提供了环境 慢性阻塞性肺疾病和其他心肺疾病患者姑息治疗的效果。

PROJECT SUMMARY Millions of Americans with COPD experience burdensome symptoms, reduced quality of life, and undesirable end-of-life care. Increasing palliative care for this vulnerable population is widely advocated to improve these important patient-centered outcomes. Yet patients with COPD rarely receive palliative care due, in part, to difficulties identifying which patients have unmet palliative care needs and palliative care workforce shortages. The proposed study's core objective is to address the national priority of improving palliative care for patients with COPD by developing an efficient, innovative, and patient-centered method to identify those with unmet palliative care needs. Specifically, the candidate seeks to (1) assess patients with COPD to determine their palliative care needs; (2) develop and validate an electronic health record-based classification model for each domain of palliative care needs; and (3) evaluate the relationship between the probability of having unmet palliative care needs and patient-centered clinical outcomes. The study will involve an in-person cross- sectional survey of 432 hospitalized patients with COPD of any stage. Participants will complete a validated survey to capture a wide variety of palliative care needs, which will be supplemented with expert chart review to identify patients with needs in any of three clinically relevant and actionable domains. These cases will be used as the patient-reported reference standard for development and validation of domain-specific classification models leveraging natural language processing of unstructured clinical text in electronic health records and machine learning methods. Finally, a large, multicenter retrospective cohort study will evaluate the associations between different probabilities of having unmet palliative care needs and several clinical outcomes important to patients, caregivers, and hospitals. This will enable the identification of thresholds of probabilities of unmet needs above which COPD patients' risks of undesirable clinical outcomes increase. Such patients will then be targeted for enrollment in future trials testing interventions to improve these outcomes. Completion of this research will build upon the candidate's past training, which includes a Masters in Health Policy Research obtained with NHLBI T32 support, an F32-supported post-doctoral fellowship, and a career development award from the National Palliative Care Research Center, and will provide the experience, education, and mentorship to allow the candidate to become a fully independent investigator. The candidate's rigorous training plan, focused on obtaining advanced skills in multisite prospective research, patient-centered outcomes research, and advanced bioinformatics methods will allow her to submit successful R01 or PCORI applications testing interventions directly informed by the results of this work. The candidate's primary mentor, collaborators, and advisors will ensure adherence to the proposed timeline and goals and provide a supportive environment for her to develop an independent research career focused on improving the uptake and effectiveness of palliative care for patients with COPD and other cardiopulmonary diseases.