Emergency General Surgery Treatment of Older Multimorbid Patients

老年多病患者的紧急普通外科治疗

• 批准号: 10532140
• 负责人: Claire Rosen
• 金额: $ 7.62万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-23 至 2023-08-22
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10532140
• 关键词: Academic Medical Centers; Academy; Address; Adherence; Admission activity; Adult; Advocate; Affordable Care Act; Age; American; Bioethics; Cardiology; Caring; Cessation of life; Client satisfaction; Clinical; Clinical Practice Guideline; Communication; Communication Tools; Complex; Complication; Consultations; Counseling; Data; Data Analyses; Decision Making; Degree program; Destinations; Education; Elderly; Emergency Situation; Emergency department visit; Emotional; Faculty; Family; Focus Groups; Foundations; Future; Goals; Grant; Health; Health Care Costs; Health Personnel; Health Policy; Health Resources; Healthcare; Hospitalization; International; Knowledge; Laparotomy; Life; Master of Science; Medical; Medical Ethics; Medicare claim; Mentors; Methods; Operative Surgical Procedures; Outcome; Patient Care; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pennsylvania; Physicians; Population; Positioning Attribute; Procedures; Provider; Public Health; Qualifying; Quality of Care; Replicating Effective Programs; Research; Research Ethics; Research Personnel; Research Training; Resources; Risk; Science; Scientist; Structure; Surgeon; Techniques; Time; Training; United States; Universities; Work; base; burden of illness; cohort; college; comorbidity; end of life; health care service utilization; implementation framework; implementation science; improved; instrument; mortality; multidisciplinary; multiple chronic conditions; novel; older patient; operation; overtreatment; patient expectation; patient oriented; surgery outcome; tool; treatment choice; treatment planning; wasting

PROPOSAL SUMMARY/ABSTRACT Each year in the United States, there are three million emergency general surgery hospital admissions, with 30% of these patients requiring surgical intervention. Multimorbid, older patients are a complex population encompassing immense health resource utilization, but outcomes data regarding the impact of multimorbidity on older emergency general surgery patients are lacking. This limits surgeon ability to set realistic expectations for patients, which is key to enacting goal-concordant care. Patient-centered care is a national standard under the Patient Protection and Affordable Care Act and has been shown to improve health outcomes and patient satisfaction. The “Best case/Worst case” communication tool is a validated instrument to facilitate treatment choice by using scenario planning to improve patient understanding of realistic outcomes. The impact of data on the use of this tool, however, has not yet been characterized. This project will (1) define the impact of multimorbidity on outcomes for older patients requiring emergency general surgery operations using comprehensive nationwide data analysis, (2) characterize the barriers and facilitators of integrating novel data into the Best case/Worst case communication tool through focus groups and complex qualitative analysis, and (3) create an education tool kit to integrate data into using the Best case/Worst case tool using implementation science. Beyond supporting the above research, the training goal of this project is to further Dr. Claire Rosen’s training in mixed methods biomedical ethics research with a focus on patient communication, and to prepare her to become an independent investigator. The above grant will support the education of Dr. Rosen, who will pursue a Master of Science in Medical Ethics through the University of Pennsylvania Department of Medical Ethics and Health Policy. This degree program has a primary goal of training physician-scientists aspiring to empirically oriented bioethics faculty positions in academic medical centers through structured content and scientific methods coursework and mentored research. This project fills a knowledge gap regarding the outcomes of multimorbid older emergency general surgery patients and uses qualitative analysis and implementation science to improve patient-centered care and communication, striving towards national demands for higher quality care. The work will be a major step in enabling Dr. Rosen to become an independent investigator, expert in biomedical ethics, and advocate for older, multimorbid emergency general surgery patients.

提案摘要/摘要 在美国，每年有300万急诊普通外科住院，其中30% 需要手术治疗的患者。多病、老年患者是一个复杂的人群 包括巨大的卫生资源利用，但结果数据的影响， 老年急诊普外科患者缺乏。这限制了外科医生设定现实期望的能力， 患者，这是制定目标一致性护理的关键。以病人为中心的护理是国家标准， 患者保护和负担得起的医疗法案，并已被证明可以改善健康结果和患者 满意“最佳情况/最差情况”沟通工具是一种经过验证的工具，可促进治疗 通过使用情景规划来改善患者对现实结果的理解。数据对 然而，这一工具的使用情况尚未确定。该项目将（1）确定 需要急诊普通外科手术的老年患者的多项预后评估， 全面的全国性数据分析，（2）描述整合新数据的障碍和促进因素 通过焦点小组和复杂的定性分析，将最佳情况/最差情况纳入沟通工具， (3)创建一个教育工具包，以便使用最佳情况/最差情况工具将数据集成到实施中 科学除了支持上述研究，该项目的培训目标是进一步博士克莱尔罗森的 混合方法生物医学伦理研究培训，重点是患者沟通，并为她做好准备 成为一名独立调查员上述赠款将支持罗森博士的教育，他将继续 宾夕法尼亚大学医学伦理系医学伦理学硕士， 卫生政策。这个学位课程的主要目标是培养渴望从经验上 通过结构化的内容和科学的方法，在学术医学中心的生物伦理学教师职位 方法课程和指导研究。该项目填补了关于以下成果的知识空白： 多病老年急诊普外科患者，并采用定性分析和实施科学 改善以病人为中心的护理和沟通，努力满足国家对更高质量护理的要求。 这项工作将是使罗森博士成为一名独立的研究者、生物医学专家的重要一步。 伦理，并倡导老年人，多病急诊普外科患者。

项目成果

The Conditional Effects of Multimorbidity on Operative Versus Nonoperative Management of Emergency General Surgery Conditions: A Retrospective Observational Study Using an Instrumental Variable Analysis.

多种发病率对紧急普通外科手术与非手术治疗的条件影响：使用工具变量分析的回顾性观察研究。

• DOI: 10.1097/sla.0000000000005901
• 发表时间: 2023
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Rosen,ClaireB;Roberts,SanfordE;Wirtalla,ChrisJ;Keele,LukeJ;Kaufman,ElinoreJ;Halpern,ScottD;Reilly,PatrickM;Neuman,MarkD;Kelz,RachelR
• 通讯作者: Kelz,RachelR

A study analyzing outcomes after bariatric surgery by primary language.

一项按主要语言分析减肥手术后结果的研究。

• DOI: 10.1007/s00464-023-10127-5
• 发表时间: 2023
• 期刊: Surgical endoscopy
• 作者: Rosen,ClaireB;Roberts,SanfordE;Sharpe,James;Gershuni,Victoria;Altieri,MariaS;Kelz,RachelR
• 通讯作者: Kelz,RachelR

Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions.

种族对急诊普通外科手术和非手术结果的条件影响。

• DOI: 10.1097/mlr.0000000000001883
• 发表时间: 2023
• 期刊: Medical care
• 影响因子: 3
• 作者: Roberts,SanfordE;Rosen,ClaireB;Keele,LukeJ;Kaufman,ElinoreJ;Wirtalla,ChristopherJ;Syvyk,Solomiya;Reilly,PatrickM;Neuman,MarkD;McHugh,MatthewD;Kelz,RachelR
• 通讯作者: Kelz,RachelR

Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study.

• DOI: 10.1097/xcs.0000000000000303
• 发表时间: 2022-11-01
• 期刊: Journal of the American College of Surgeons
• 影响因子: 5.2

A Novel Mobile App to Identify Patients With Multimorbidity in the Emergency Setting: Development of an App and Feasibility Trial.

• DOI: 10.2196/42970
• 发表时间: 2023-07-13
• 期刊: JMIR FORMATIVE RESEARCH
• 影响因子: 2.2
• 作者: Rosen, Claire Barthlow;Roberts, Sanford Eugene;Syvyk, Solomiya;Finn, Caitlin;Tong, Jason;Wirtalla, Christopher;Spinks, Hunter;Kelz, Rachel Rapaport
• 通讯作者: Kelz, Rachel Rapaport