Describing, Contrasting, and Visualizing End-of-Life Care in the 21st Century

描述、对比和形象化 21 世纪的临终关怀

• 批准号: 8509532
• 负责人: GAIL M KEENAN
• 金额: $ 47.62万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-09 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8509532
• 关键词: Acute; Admission activity; Adverse event; Anxiety; Benchmarking; Cardiopulmonary; Care given by nurses; Caring; Cessation of life; Code; Computers; Data; Data Set; Databases; Diagnosis; Discipline of Nursing; Effectiveness; Electronic Health Record; Electronics; Evidence based practice; Family; Feedback; Focus Groups; Future; Goals; Hospital Units; Hospitalization; Hospitals; Hour; Imagery; Informatics; Intervention; Knowledge; Length of Stay; Life; Measurement; Medicare; Methods; Nurses; Nursing Diagnosis; Outcome; Pain; Pain management; Patients; Pattern; Persons; Practice based research; Process; Provider; Recording of previous events; Records; Risk; Sampling; Specific qualifier value; System; Terminology; Testing; Time; Translating; Videotape; Visual; base; care episode; clinical Diagnosis; clinically significant; data mining; demographics; end of life; fall risk; hospice environment; innovation; iterative design; meetings; nutrition; point of care; prospective; simulation; tool; usability

DESCRIPTION (provided by applicant): Our long-term goal is to reveal benchmarks and best practices for end-of-life (EOL) nursing care that support patients' dignity and comfort. Millions of dollars are spent each year on treatments of questionable value to hospitalized patients who are near death. The maturation of the electronic health records (EHRs) and standardized terminologies now make it possible to capture data and use it to determine the benchmarks and best practices of effective care or risks for adverse events. In our preliminary study of an extensive HANDS database of actual nursing care practices with 39,322 care episodes, we identified 1,394 EOL patients and we examined their "pain care" to demonstrate the feasibility of our methods and adequacy of power to determine effective pain benchmarks. This study yielded 4 statistically significant and clinically important benchmarks: (1) 51% of EOL patients failed to meet expected pain outcomes at discharge to hospice or death; (2) pain control achieved in the first 24 hours of care was predictive of pain control for the entire stay; (3) EOL patients with both cardiopulmonary and pain diagnoses had significantly poorer pain outcomes than those who do not; and (4) certain interventions were more likely to achieve pain control. We translated these pain benchmarks into an EHR user interface that is now ready for usability testing by a prospective sample. Building on these important findings, we propose to identify benchmarks and best practices for 5 additional care problems and 5 combinations of problems that are common to hospitalized EOL patients. From the validated dataset of care plan histories for 1,394 EOL patients from 8 different acute care units in 4 Midwestern hospitals, we will characterize EOL care using the following attributes: 1) patient and provider demographics; and 2) the nursing diagnoses, interventions, and outcomes as they evolved during each patient's care episode. Once we determine the benchmarks, then we will build a benchmarking system that presents the findings visually on EHR computer screens that help nurses to see and use the benchmarks as they plan and document care in the EHR. Our specific aims are to: Aim1. Determine patterns among all attributes recorded in HANDS for meaningful associations among the attributes that reveal benchmarks and best practices. Aim 2. In a diverse sample of 75 nurses, determine the usability (accessibility, visual appeal, content utility to guide intended use at the point of care) of new visualization screens that display the benchmarks for outcome pattern ratings (at the level of the person, unit, hospital, and across the 4 hospitals) and best practices. Study findings will inform future prospective practice-based research to verify the effectiveness of the benchmarking system to produce desired outcomes for hospitalized EOL patients. Such findings are urgently needed to enable best practice nursing care that supports hospitalized EOL patients' dignity and comfort as they die.

描述（由申请人提供）：我们的长期目标是揭示临终 (EOL) 护理的基准和最佳实践，以支持患者的尊严和舒适。每年有数百万美元用于对濒临死亡的住院患者进行价值可疑的治疗。电子健康记录 (EHR) 和标准化术语的成熟现在使得捕获数据并使用它来确定有效护理或不良事件风险的基准和最佳实践成为可能。在我们对包含 39,322 次护理事件的实际护理实践的广泛 HANDS 数据库进行的初步研究中，我们确定了 1,394 名 EOL 患者，并检查了他们的“疼痛护理”，以证明我们的方法的可行性以及确定有效疼痛基准的能力是否充足。这项研究得出了 4 个具有统计学意义和临床意义的基准：(1) 51% 的 EOL 患者在出院接受临终关怀或死亡时未能达到预期的疼痛结果； (2) 在护理的前 24 小时内实现的疼痛控制可以预测整个住院期间的疼痛控制； (3) 同时具有心肺和疼痛诊断的 EOL 患者的疼痛结果明显较差于未进行心肺和疼痛诊断的患者； (4)某些干预措施更有可能实现疼痛控制。我们将这些疼痛基准转化为 EHR 用户界面，现已准备好通过前瞻性样本进行可用性测试。基于这些重要发现，我们建议为住院 EOL 患者常见的 5 种额外护理问题和 5 种问题组合确定基准和最佳实践。根据来自 4 家中西部医院 8 个不同急诊室的 1,394 名 EOL 患者的护理计划历史经过验证的数据集，我们将使用以下属性来描述 EOL 护理的特征：1）患者和提供者的人口统计数据； 2) 在每个患者的护理过程中，护理诊断、干预措施和结果的演变。一旦我们确定了基准，我们将建立一个基准系统，在 EHR 计算机屏幕上直观地呈现结果，帮助护士在 EHR 中计划和记录护理时查看和使用基准。我们的具体目标是： 目标1。确定 HANDS 中记录的所有属性之间的模式，以便在揭示基准和最佳实践的属性之间建立有意义的关联。目标 2. 在 75 名护士的不同样本中，确定新可视化屏幕的可用性（可访问性、视觉吸引力、指导护理点预期使用的内容实用性），这些屏幕显示结果模式评级基准（在个人、单位、医院和 4 家医院层面）和最佳实践。研究结果将为未来基于实践的前瞻性研究提供信息，以验证基准测试系统为住院 EOL 患者产生预期结果的有效性。迫切需要这些发现来实现最佳护理实践，以支持住院生命垂危患者在死亡时的尊严和舒适。