ASTHMA HEALTH OUTCOMES FOLLOWING INTENSIVE CARE

重症监护后的哮喘健康结果

• 批准号: 6479188
• 负责人: MARK DOUGLAS EISNER
• 金额: $ 4.52万
• 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/6479188
• 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.

背景资料。自20世纪70年代末以来，美国哮喘死亡率急剧上升。由于死于哮喘的情况很少，前瞻性研究一直很难进行。既往住院，特别是ICU入院，定义了哮喘健康结局不良的高危人群。(1)评价健康护理过程因素--医生专业、哮喘药物、自我管理计划处方和环境控制措施--对高危成人哮喘患者健康结局的影响。(2)阐明患者层面的特征--对哮喘、抑郁和哮喘严重程度的感知控制--对哮喘结果的影响。为了收集一组患有严重哮喘的成年人，我们将前瞻性地研究所有符合条件的北加州凯撒永久(KP)成年成员在3年内因哮喘住院(目标n=3600)。最高风险的患者，在ICU哮喘入院后(n=500)，将接受结构化电话访谈。使用计算机和访谈数据，我们将勾勒出与哮喘结果相关的因素：再次住院、紧急医疗保健利用和医疗保健费用。这项拟议的研究将详细阐述与哮喘高危成人纵向健康结果差相关的因素，确定临床和政策干预的目标。作为目前的NRSA获得者，艾斯纳博士在他为期两年的博士后研究奖学金期间进行了成人哮喘的流行病学研究。拟议的K23奖项将在流行病学、健康结果和生物统计学方面提供以患者为导向的高级研究培训。职业发展计划包括：(1)独立进行前瞻性队列研究(2)由多学科科学咨询委员会提供正式指导(3)高级教学培训，获得公共卫生硕士学位。这一奖项将使艾斯纳博士继续发展成为一名独立的临床研究员。