The Obese Critical Ill: Process and Outcome Disparities

描述(由申请人提供)： 候选人：小詹姆斯·M·奥布莱恩医学博士致力于成为重症监护健康服务研究的独立研究员，关注以患者为导向的结果和护理过程。他的背景包括在学术医学方面的坚实基础，在肺部和重症护理医学方面的出色培训，以及适用于他未来研究计划的学术工作。他的才华将为ICU患者提供高质量护理的热情与研究提供护理的过程和扩大用于评估危重患者的结果衡量标准的曲目结合在一起。K23职业发展奖将为他提供继续培训和推进研究目标所需的时间和支持。环境：为O‘Brien博士提供的导师和机构资源为在一个相对较新的领域-危重护理卫生服务研究-创造了一个独特的职业发展环境。安德鲁·克莱默医学博士(赞助人)和卡罗琳·威尔什医学博士(共同赞助人)分别带来了医疗服务研究和临床危重护理研究方面的专业人才互补，为候选人提供跨越以患者为中心的研究传统边界的支持。候选人的任命是通过科罗拉多大学健康科学中心的肺科学和重症护理医学部进行的，尽管他将继续受益于卫生保健政策和研究部的资源。研究：拟议研究的全球目标是更好地理解超重作为危重疾病和不符合标准的ICU护理(由过程测量确定)更糟糕结局的风险因素所起的作用。一项前瞻性、观察性的队列研究将探索肥胖对以下方面的影响：(1)短期临床结果(不使用呼吸机的天数)；(2)资源利用(ICU住院时间)；(3)长期存活率；(4)以患者为导向的结果衡量标准(与健康有关的生活质量)。在这项研究中，我们还将关注作为护理质量替代指标的过程措施(机械通气“脱机”持续时间和TISS-28评分)。这些研究将描述超重对危重疾病的影响，并产生一种新型的独立调查者--ICU卫生服务研究员。

DESCRIPTION (provided by applicant): Candidate: James M. O'Brien, Jr., MD is committed to becoming an independent researcher in critical care health services research with interests in patient-oriented outcomes and processes of care. His background includes a strong foundation in academic medicine, excellent training in pulmonary and critical care medicine, and scholarly work applicable to his future research plans. His talents combine a passion for providing high quality care to ICU patients with a driving interest to study the processes of provided care and to expand the repertoire of outcome measures used to evaluate critically ill patients. The K23 career development award will provide the time and support required for him to continue his training and advance his research objectives. Environment: The mentorship and institutional resources available to Dr. O'Brien create a unique environment for the nurturing of a career in a relatively novel field: critical care health services research. Andrew Kramer, MD (sponsor) and Carolyn Welsh, MD (co-sponsor) bring the complementary talents of expertise in health service research and clinical critical care research, respectively, to provide the candidate with support that crosses traditional boundaries of patient-oriented research. The candidate's appointment is through the Division of Pulmonary Science and Critical Care Medicine at the University of Colorado Health Sciences Center although he will continue to benefit from the resources of the Division of Health Care Policy and Research. Research: The global ambition of the proposed studies is to better understand the role of excess body weight as a risk factor for worse outcomes from critical illness and for substandard ICU care (as determined by process measures). A prospective, observational, cohort study will explore the influence of obesity on (1) short-term clinical outcomes (number of ventilator-free days); (2) resource utilization (ICU length of stay); (3) long-term survival; and (4) patient-oriented outcome measures (health-related quality of life). In this study, we will also attend to process measures (duration of "weaning" from mechanical ventilation and TISS-28 scores) as a surrogate for the quality of care. These studies will describe the effect of excess body weight on critical illness and produce a new type of independent investigator - the ICU health services researcher.