Development and validation of an Instrument to Measure Critical Care Organization

描述（由申请人提供）： 该奖项将为Kahn博士提供一个机会，使其成为临床研究领域的独立科学调查员，调查危重病和急性肺损伤的医疗保健提供方面。这将通过生物统计学和卫生服务研究的正式课程的综合计划，当地专家的密集指导以及设计，进行和解释临床研究项目的实践经验来完成。Kahn博士将利用这一奖项成为一名训练有素的临床研究人员，具有分层多变量统计建模和仪器开发与验证方面的技能。这将导致一个成功的独立研究生涯，重点是了解与改善机械通气患者的护理过程和结果相关的重症监护病房（ICU）的组织因素。该研究的主要科学目标是前瞻性地开发和验证一种工具，以衡量ICU中机械通气患者的重症监护服务组织。这将在金郡肺损伤项目（KCLIP）的框架内完成，该项目是一个由21家医院组成的网络，旨在对急性肺损伤患者进行基于人群的流行病学研究。具体目标该项目之一是在KCLIP ICU内使用定向访谈和焦点小组，以开发一种简短的调查工具，测量ICU组织的重要方面。具体目标二将在衍生队列上测试该工具的可靠性和有效性，并使用因子分析来确定构成ICU组织的主要独立组成部分（包括医生人员配置模式、多学科护理使用、提供者沟通和整体ICU文化）。具体目标三将通过测量全国样本中机械通气患者的ICU护理组织与死亡率和ICU住院时间之间的相关性来验证该工具。本研究与公共卫生的相关性：本研究将提供有关如何最好地组织重症监护服务的重要信息，以便为急性肺损伤和呼吸衰竭患者提供最佳循证护理。在这项研究中产生的工具将用于未来的研究，检查具体的干预措施，以改善ICU的组织。(End摘要）

DESCRIPTION (provided by applicant): This award will provide an opportunity for Dr. Kahn to develop as an independent scientific investigator in the field of clinical research investigating aspects of health care delivery in critical illness and acute lung injury. This will be accomplished through an integrated program of formal coursework in biostatistics and health services research, intensive mentoring by local experts, and practical experience in designing, conducting, and interpreting a clinical research project. Dr. Kahn will use this award to become a well-trained clinical investigator with skills in hierarchical multivariate statistical modeling and instrument development and validation. This will lead to a successful independent research career focused on understanding the organizational factors of intensive care units (ICUs) that are related to improved process of care and outcome in mechanically ventilated patients. The primary scientific goal of the study is to prospectively develop and validate an instrument to measure the organization of critical care services for mechanically ventilated patients in the ICU. This will be accomplished within the framework of the King County Lung Injury Project (KCLIP), a twenty-one hospital network developed to conduct population-based epidemiologic studies of patients with acute lung injury. Specific Aim One of the project uses directed interviews and focus groups within KCLIP ICUs to develop a brief survey instrument measuring important aspects of ICU organization. Specific Aim Two will test the reliability and validity of the instrument on the derivation cohort and use factor analysis to determine major independent components that comprise ICU organization (including physician staffing patterns, multidisciplinary care use, provider communication and overall ICU culture). Specific Aim Three will validate the instrument by measuring the association between the organization of ICU care with mortality and ICU length of stay in mechanically ventilated patients in a national sample. Relevance of this research to pubic health: This study will provide important information regarding how to best organize critical care services in order to provide optimal evidence-based care to patients with acute lung injury and respiratory failure. The instrument generated in this research will be used in future studies examining specific interventions to improve ICU organization. (End of Abstract)