Development of instrument--critical care organization

描述(由申请人提供)： 这一奖项将为卡恩博士提供一个机会，让他在临床研究领域发展成为一名独立的科学研究员，调查危重疾病和急性肺损伤的医疗保健服务的各个方面。这将通过生物统计学和卫生服务研究的正式课程、当地专家的密集指导以及设计、实施和解释临床研究项目的实践经验的综合计划来实现。卡恩博士将利用这一奖项成为一名训练有素的临床研究员，拥有分层多元统计建模以及仪器开发和验证方面的技能。这将导致一个成功的独立研究生涯，专注于了解重症监护病房(ICU)的组织因素，这些因素与改善机械通气患者的护理过程和结果有关。这项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的组织情况。这将在金县肺损伤项目(KCLIP)的框架内完成，该项目是一个21个医院网络，旨在对急性肺损伤患者进行基于人群的流行病学研究。具体目的其中一个项目使用KCLIP ICU中的定向访谈和焦点小组来开发一种简短的调查工具，衡量ICU组织的重要方面。具体目标二将测试该工具在派生队列上的可靠性和有效性，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)。具体目标三将通过在全国样本中衡量ICU护理组织与机械通气患者死亡率和ICU住院时间之间的关联来验证该工具。这项研究与公共健康的相关性：这项研究将提供关于如何最好地组织危重护理服务的重要信息，以便为急性肺损伤和呼吸衰竭患者提供最佳的循证护理。这项研究产生的工具将用于未来的研究，检查改善ICU组织的具体干预措施。(摘要结束)

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)