ASTHMA HEALTH OUTCOMES FOLLOWING INTENSIVE CARE

重症监护后的哮喘健康结果

• 批准号: 6024291
• 负责人: MARK DOUGLAS EISNER
• 金额: $ 12.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-02-15 至 2005-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6024291
• 关键词: asthma; behavioral /social science research tag; clinical research; disease /disorder proneness /risk; health care cost /financing; health care service utilization; health services research tag; human subject; intensive care; longitudinal human study; outcomes research; patient care management

Background. Since the late 1970s, the U.S. mortality rate from asthma has risen sharply. Because death from asthma is rare, prospective studies have been difficult to perform. Prior hospitalization, especially ICU admission, defines a group at high risk for adverse asthma health outcomes. (1) To evaluate the impact of health care process factors - physician specialty, asthma medications, prescription of self-management plans, and environmental control measures - on health outcomes among high risk adult asthmatics. (2) To elucidate the effect of patient-level characteristics - perceived control of asthma, depression, and asthma severity - on asthma outcomes. To assemble a cohort of adults with severe asthma, we will prospectively study all eligible adult Northern California Kaiser Permanents (KP) members hospitalized for asthma during a 3 Year period (target n=3600). The highest risk patients, following ICU admission for asthma (n=500), will undergo structured telephone interviews. Using both computerized and interview data, we will delineate the factors associated with asthma outcomes: re-hospitalization, urgent health care utilization, and health care cost. The proposed study will elaborate the factors associated with poor longitudinal health outcomes among high risk adults with asthma, identifying targets for clinical and policy interventions. A current NRSA recipient, Dr. Eisner has conducted epidemiologic research in adult asthma during his 2-year postdoctoral research fellowship. The proposed K23 award would provide advanced patient-oriented research training in epidemiology, health outcomes, and biostatistics. The career development plan includes: (1) independently conducting a prospective cohort study (2) formal mentoring from a multi- disciplinary scientific advisory committee (3) advanced didactic training, leading to an MPH degree. This award will enable Dr. Eisner's continued progression to an independent clinical investigator.

背景。自20世纪70年代末以来，美国哮喘死亡率急剧上升。由于哮喘导致的死亡很少，因此很难进行前瞻性研究。既往住院，特别是ICU住院，定义了不良哮喘健康结局的高危人群。(1)评价卫生保健过程因素（医师专业、哮喘药物、自我管理计划处方和环境控制措施）对成人高危哮喘患者健康结局的影响。(2)阐明患者水平特征——哮喘知觉控制、抑郁和哮喘严重程度对哮喘转归的影响。为了组建一个患有严重哮喘的成人队列，我们将前瞻性研究所有符合条件的北加州Kaiser Permanents （KP）在3年内因哮喘住院的成人会员（目标n=3600）。风险最高的患者，在因哮喘而进入ICU后（n=500），将接受结构化的电话访谈。使用计算机和访谈数据，我们将描述与哮喘结局相关的因素：再次住院、紧急医疗保健利用和医疗保健费用。拟议的研究将详细阐述与哮喘高危成人不良纵向健康结果相关的因素，确定临床和政策干预的目标。作为目前的nssa接受者，Eisner博士在他2年的博士后研究期间进行了成人哮喘的流行病学研究。拟议的K23奖将在流行病学、健康结果和生物统计学方面提供先进的以患者为导向的研究培训。职业发展计划包括：(1)独立进行前瞻性队列研究(2)多学科科学咨询委员会的正式指导(3)高级教学培训，最终获得硕士学位。该奖项将使艾斯纳博士继续发展成为一名独立的临床研究者。