Defining Optimal Clinical Strategies for Critically Ill Heart Failure Patients

为危重心力衰竭患者制定最佳临床策略

• 批准号: 8510076
• 负责人: Tara C Lagu
• 金额: $ 13.09万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510076
• 关键词: Accounting; Admission activity; Adrenergic beta-Antagonists; Affect; Age; American; Cardiovascular system; Caring; Catheters; Characteristics; Clinical; Code; Collaborations; Critical Care; Critical Illness; Data; Data Set; Databases; Development; Diagnosis; Diagnostic; Diastolic heart failure; Diuretics; Environmental air flow; Etiology; Evidence based practice; Faculty; Future; Goals; Heart; Heart failure; Heterogeneity; Hospital Mortality; Hospital Personnel; Hospitalization; Hospitals; Internist; Interview; Intravenous; Lead; Link; Massachusetts; Mechanical ventilation; Medical center; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; Observational Study; Oral; Organ; Outcome; Patient Care; Patients; Peer Group; Performance; Pharmaceutical Preparations; Population; Population Study; Process; Published Comment; Pulmonary artery structure; Qualitative Methods; Quality of Care; Questionnaires; Records; Reducing Agents; Reporting; Research; Research Personnel; Research Proposals; Research Training; Resources; Risk; Risk Factors; Sample Size; Sampling; Severities; Subgroup; Supportive care; Systolic heart failure; Testing; Time; Training; Tube; Universities; Validation; Variant; Vasoconstrictor Agents; Wood material; Work; aged; base; billing data; clinical practice; cohort; comparative; cost; endotracheal; evidence base; experience; human old age (65+); improved; informant; interest; medical schools; member; mortality; pressure; professor; public health relevance; response; skills

DESCRIPTION (provided by applicant): This is a resubmission application for a K01 award for Tara Lagu, MD, MPH, a board-certified internist and Assistant Professor at the Tufts University School of Medicine. Dr. Lagu is based in the Center for Quality of Care Research (CQCR) at Baystate Medical Center (BMC) in Springfield, Massachusetts. Dr. Lagu's focus is on the quality and outcomes of care for patients with heart failure (HF). Her long-term goal is to become an independent cardiovascular outcomes researcher. Her immediate goals are 1) to use quantitative and qualitative methods to define optimal clinical strategies for the care of critically ill patients with HF and 2) to develop, through mentorship and formal coursework, skills that will help her to become an independent investigator. Her training as a Robert Wood Johnson Clinical Scholar and experience as a young faculty member at BMC will help her to accomplish these goals. Dr. Lagu has assembled a mentorship team with expertise in both the proposed work and in helping junior faculty transition to independence. Her primary mentor is Dr. Peter Lindenauer. Her co-mentor is Dr. Harlan Krumholz. Consultants include Dr. Penelope Pekow (biostatistician) and Dr. Kathleen Mazor (psychometrician). Dr. Lagu will have full access to the resources of both BMC and Tufts University School of Medicine. The CQCR (directed by Dr. Lindenauer, in collaboration with a group of senior faculty), which will provide mentorship, biostatistical, and administrative support as well as a peer group of junior faculty with similar interests. This research proposal aims to answer the question: "What are the clinical strategies that enable hospitals to achieve lower risk-adjusted mortality rates for critically ill patients wih HF?" Critically ill HF patients have a 30-day mortality rate as high as 20%, indicating that these patients contribute disproportionately to reported hospital variation in HF risk adjusted mortality rates, yet there are no large observational studies of these patients. We will first develop a mortality prediction method for use in observational studies of critically ill HF patients that taks advantage of a unique and powerful dataset. In response to reviewer comments, we have included markers of HF etiology in this model and will separately validate the model in subgroups with known HF etiology. Next, we will examine variation in risk-adjusted mortality and will determine the proportion of variation that can be explained by differences in use of evidence-based clinical practices. Because we anticipate that most of the observed variation in risk-adjusted outcomes will remain unexplained, in Aim 3 we will develop qualitative methods that can be used to identify the clinical strategies and practices employed by hospitals with low risk-adjusted mortality rates for this population. These methods will generate preliminary data for an R01 that will include qualitative interviews from many more hospitals and will validate the hypotheses through a random sample questionnaire linked to hospital performance.

描述（由申请人提供）：这是一个重新提交申请的K 01奖塔拉拉古，医学博士，公共卫生硕士，董事会认证的内科医生和助理教授在塔夫茨大学医学院。Lagu博士在马萨诸塞州斯普林菲尔德的Baystate医学中心（BMC）的护理质量研究中心（CQCR）工作。Lagu博士的重点是心力衰竭（HF）患者的护理质量和结果。她的长期目标是成为一名独立的心血管结局研究人员。她的近期目标是：1）使用定量和定性方法来确定HF危重患者护理的最佳临床策略; 2）通过指导和正式课程， 帮助她成为一名独立调查员她作为罗伯特·伍德约翰逊临床学者的培训和作为BMC年轻教员的经验将帮助她实现这些目标。Lagu博士组建了一个导师团队，他们在拟议的工作和帮助初级教师向独立过渡方面都具有专业知识。她的主要导师是Peter Lindenauer博士。她的导师是哈兰·克鲁姆霍尔茨博士顾问包括Penelope Pekow博士（生物统计学家）和Kathleen Mazor博士（心理测量师）。Lagu博士将可以充分利用BMC和塔夫茨大学医学院的资源。Lindenauer，与一组高级教师合作），这将提供指导，生物统计和行政支持，以及具有类似兴趣的初级教师的同行小组。 本研究提案旨在回答以下问题：“使医院能够降低HF危重患者风险调整死亡率的临床策略是什么？“危重HF患者的30天死亡率高达20%，这表明这些患者对HF风险调整死亡率的医院差异有不成比例的贡献。 率，但没有对这些患者进行大型观察性研究。我们将首先开发一种死亡率预测方法，用于重症HF患者的观察性研究，该方法利用了独特而强大的数据集。作为对评审意见的回应，我们在该模型中纳入了HF病因学标志物，并将在已知HF病因的亚组中单独验证该模型。接下来，我们将检查风险调整死亡率的变化，并确定可以通过使用循证临床实践的差异来解释的变化比例。因为我们预计，大多数观察到的风险调整后的结果的变化将仍然无法解释，在目标3中，我们将开发定性方法，可用于确定临床策略和实践所采用的医院与低风险调整后的死亡率为这一人群。这些方法将为R 01生成初步数据，其中包括来自更多医院的定性访谈，并将通过与医院绩效相关的随机抽样问卷来验证假设。