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

项目摘要 数百万患有COPD的美国人经历了沉重的症状，生活质量降低，以及不期望的疾病。 临终关怀人们广泛提倡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成果。然而，COPD患者很少接受姑息治疗，部分原因是 难以确定哪些患者的姑息治疗需求未得到满足，姑息治疗工作人员短缺。 这项拟议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 通过开发一种有效、创新和以患者为中心的方法， 姑息治疗的需求。具体而言，候选人寻求（1）评估COPD患者，以确定其 姑息治疗需求;（2）为每个人开发并验证基于电子健康记录的分类模型 域的姑息治疗需求;和（3）评估之间的关系，有未满足的概率 姑息治疗需求和以患者为中心的临床结果。这项研究将涉及一个人的交叉- 对432例COPD各期住院患者进行横断面调查。参与者将完成一个经过验证的 调查以获取各种姑息治疗需求，并辅以专家图表审查 识别在三个临床相关和可操作领域中任何一个领域有需求的患者。这些个案会 用作患者报告的参考标准，用于开发和验证领域特异性 电子健康中利用非结构化临床文本的自然语言处理的分类模型 记录和机器学习方法。最后，一项大型多中心回顾性队列研究将评估 未满足姑息治疗需求的不同概率与几种临床 结果对患者、护理人员和医院都很重要。这将有助于确定 未满足需求的概率，高于该概率，COPD患者的不良临床结局风险增加。 然后，这些患者将成为未来试验的目标，测试干预措施，以改善这些症状。 结果。这项研究的完成将建立在候选人过去的培训，其中包括硕士 在卫生政策研究获得了NHLBI T32的支持，F32支持的博士后奖学金，和 职业发展奖从国家姑息治疗研究中心，并将提供经验， 教育和指导，使候选人成为一个完全独立的调查员。候选人的 严格的培训计划，专注于获得多中心前瞻性研究的高级技能，以患者为中心 结果研究，先进的生物信息学方法将使她能够提交成功的R 01或PCORI 应用程序测试干预直接告知这项工作的结果。候选人的主要导师， 合作者和顾问将确保遵守拟议的时间轴和目标，并提供支持 环境，她发展一个独立的研究生涯，重点是提高吸收和 慢性阻塞性肺疾病及其他心肺疾病患者姑息治疗的有效性。

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.