ICU Discharge: A Critical Juncture for Survivors of Acute Respiratory Failure

描述（由申请人提供）：此培训资助是由一名医学博士研究生申请，准备进入临床流行病学博士学位的论文阶段。候选人渴望成为重症监护结果研究领域的领先独立医师科学家。她将在博士期间把100%的时间投入到这项研究中。她在论文阶段的实践训练，加上精心挑选的教学课程，旨在使她在使用先进的统计方法来定义重症监护暴露和结果之间的关联以及使用定性方法来深入探索机制和产生新的假设方面成为专家。这种双重训练方法将为她将来在危重病人护理过渡期间进行医患沟通的研究做好最佳准备。在整个获奖过程中，她将受到卫生服务研究、重症监护、生物统计学、生物伦理学和定性方法方面的资深专家的指导。该职业发展奖的研究部分将在三个互补项目中进行，以提高对ICU出院周围环境如何影响急性呼吸衰竭（ARF）患者及其替代患者预后的理解。在项目1中，候选人将使用国家ICU患者数据库检查ICU人口普查对ARF患者医疗结果的影响。首先，她将评估ICU普查对需要机械通气的ARF患者拔管至ICU出院时间的影响。然后，她将检查ICU普查与院内死亡和ICU再入院之间的关系，调查拔管和ICU出院之间的时间是否作为普查和负面结果之间的影响调节因子。在项目2中，她将前瞻性地收集数据来检查发生ARF需要机械通气发作的患者及其替代者的心理和信任结果。她将在ICU出院一个月后对患者和代理人进行电话访谈，并进行有效的调查，评估焦虑、抑郁和信任结果。因此，这项研究将对需要机械通气的ARF患者及其替代品的出院时间周围先前未探索的风险产生有效的测量。它将建立一个概念模型的基础，该模型将被用作未来定性研究的基础，这些研究将检查ICU出院时医疗团队与患者和代理人之间的对话内容，以确定患者和代理人认为哪些沟通元素最有帮助。最终目标是通过未来针对床位分配决策和医疗团队与患者和代理人之间沟通的干预研究来改善这一弱势患者和代理人群体的预后。

DESCRIPTION (provided by applicant): This training grant is being sought by an MD-PhD student preparing to enter the dissertation phase of her PhD in clinical epidemiology. The candidate aspires to become a leading independent physician-scientist in the field of critical care outcomes research. She will devote 100% of her time to this research for the duration of her PhD. Her hands-on training during her dissertation phase, coupled with carefully selected didactic courses, are designed to make her expert in the use of advanced statistical methods to define associations between critical care exposures and outcomes as well as in the use of qualitative methods to deeply explore mechanisms and generate new hypotheses. This dual training approach will optimally prepare her for future studies on doctor-patient communication during transitions of care for critically ill patients. Throughout this award, she will be mentored by senior experts in health services research, critical care, biostatistics, bioethics, and qualitative methods. The research portion of this career development award will proceed in three complimentary projects to improve understanding of how the circumstances surrounding ICU discharge affect the outcomes for acute respiratory failure (ARF) patients and their surrogates. In project 1, the candidate will examine the effect of ICU census on the medical outcomes of ARF patients using a national database of ICU patients. First, she will evaluate the effect of ICU census on the time between extubation and ICU discharge for ARF patients requiring mechanical ventilation. She will then examine the relationship between ICU census and in-hospital death and ICU readmission, investigating whether time between extubation and ICU discharge acts as an effect modifier between census and negative outcomes. In project 2, she will prospectively collect data to examine psychological and trust outcomes patients who suffered an episode of ARF requiring mechanical ventilation and their surrogates. She will conduct telephone interviews with patients and surrogates one month following ICU discharge and administer validated surveys that assess anxiety, depression, and trust outcomes. This research will therefore produce valid measures of the previously unexplored risks surrounding the time of discharge to ARF patients requiring mechanical ventilation and their surrogates. It will build the foundations of a conceptual model that will be used as the basis for future qualitative studies that examine the content of conversations between the health care team and patients and surrogates at the time of ICU discharge to determine which communication elements patients and surrogates find most helpful. The ultimate goal is to improve outcomes in this vulnerable group of patients and surrogates with future intervention studies targeting bed allocation decisions and communication between the health care team and patients and surrogates.