Downstream effects of end-of-life patient treatment intensity on family members

临终患者治疗强度对家庭成员的下游影响

• 批准号: 8926348
• 负责人: KATHERINE A ORNSTEIN
• 金额: $ 11.55万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8926348
• 关键词: Accounting; Admission activity; Adult; Applications Grants; Area; Atlases; Award; Caregivers; Caring; Cessation of life; Chairperson; Clinical; Clinical assessments; Cohort Studies; Complex; Cost Analysis; Data; Data Linkages; Data Set; Decision Making; Dementia; Denmark; Doctor of Philosophy; Economic Policy; Elderly; Event; Expenditure; Family; Family Caregiver; Family health status; Family member; Funding; Geriatrics; Health; Health Care Costs; Health Expenditures; Health behavior; Healthcare; Healthcare Systems; Hospice Care; Individual; Inpatients; Intensive Care; Intensive Care Units; Intubation; Knowledge; Lead; Life; Link; Longitudinal Surveys; Love; Mediating; Medicare; Medicare claim; Medicare/Medicaid; Mental Depression; Mental Health; Mentored Research Scientist Development Award; Mentorship; Outcome; Outpatients; Palliative Medicine; Pathway Analysis; Patients; Pattern; Play; Policy Maker; Population; Preparation; Preventive; Records; Registries; Research; Research Personnel; Research Project Grants; Research Training; Retirement; Role; Social Network; Spouses; Staging; Stress; Surveys; Symptoms; Testing; Time; Training; care preference; career development; cohort; cost; data registry; end of life; health care delivery; health care service utilization; health data; hospice environment; improved; instructor; loved ones; medical schools; meetings; older patient; physical conditioning; post-traumatic stress; professor; skills

DESCRIPTION (provided by applicant): This application is for a Mentored Research Scientist Development Award (K01) for Katherine Ornstein, PhD, an Instructor in Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. I propose to develop expertise in five areas that will allow me to develop a line of research into the downstream effects of end of life care on family networks: 1) data linkages; (2) economic and policy issues facing older adults with serious illness and their families including knowledge of healthcare delivery and treatments at the end of life; (3) cost analysis and use of claims data; (4) analysis of complex longitudinal surveys; and (5) social network analysis. Under the guidance of my mentorship team led by Albert Siu, MD MSPH, Professor and Chairman of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai, I will use the skills obtained in these training areas to begin to fill outstanding gaps in our understanding of how end of life care intensity impacts families with three research projects, for which the K01 will allow me protected research time. End of life care for older patients with serious illness such as dementia commonly includes high intensity treatments which may be burdensome and costly. Our understanding of how these treatments impact patients' families' health and healthcare utilization both before and after a patient's deat is limited. Current end of life healthcare cost estimates do not consider potential downstream costs associated with the healthcare expenditures of family members who care for their seriously ill loved ones. First, I will investigate the differential impact of end of life treatmens on spousal healthcare expenditures following death of older patients with serious illness using longitudinal survey data from the HRS cohort combined with individual Medicare claims and regional data from the Dartmouth Atlas of Healthcare (Aim 1). Next, I will determine the association between healthcare treatment intensity and caregiver healthcare expenditures for patients with end-stage dementia using data from HRS and a clinical cohort of dementia patients and their caregivers (Aim 2). Finally, I will characterize the trajectory of healthcare utilization for spouses before and after patient death using Denmark population registry data (Aim 3). In addition to these research aims, my K01 award period will focus on preparation of an R01 grant proposal to link healthcare utilization of decedents to the health and healthcare of all adult family members using population registries. These projects are feasible only if I have protected time for new training and research, which K01 funding will provide.

描述(由申请人提供)：本申请是为西奈山伊坎医学院老年医学和姑息医学讲师凯瑟琳·奥恩斯坦博士颁发的导师研究科学家发展奖(K01)。我建议在五个领域发展专门知识，使我能够研究临终关怀对家庭网络的下游影响：1)数据联系；(2)患有严重疾病的老年人及其家人面临的经济和政策问题，包括有关临终保健提供和治疗的知识；(3)费用分析和索赔数据的使用；(4)复杂纵向调查的分析；以及(5)社会网络分析。在西奈山布鲁克代尔老年医学和姑息医学系主任、医学MSPH教授萧伯纳领导的指导团队的指导下，我将使用在这些培训领域获得的技能来开始 为了填补我们在理解临终关怀强度如何影响家庭方面的突出空白，我进行了三个研究项目，K01将为我提供受保护的研究时间。对患有痴呆症等严重疾病的老年患者的临终护理通常包括高强度治疗，这可能是繁重和昂贵的。我们对这些治疗在患者发病前后如何影响患者家人的健康和医疗保健利用的了解有限。目前的临终医疗费用估计没有考虑与照顾其重病亲人的家庭成员的医疗支出相关的潜在下游费用。首先，我将使用来自HRS队列的纵向调查数据，结合个人医疗保险索赔和达特茅斯医疗保健地图集(目标1)的区域数据，调查生命终结治疗对患有严重疾病的老年患者死亡后配偶医疗支出的不同影响。接下来，我将使用HRS的数据以及痴呆症患者及其照顾者的临床队列数据，确定终末期痴呆症患者的医疗治疗强度与照顾者医疗支出之间的关联(目标2)。最后，我将使用丹麦人口登记数据(目标3)描述患者死亡前后配偶医疗保健利用的轨迹。除了这些研究目标，我的K01奖励期将专注于准备R01赠款提案，将死者的医疗保健利用与使用人口登记的所有成年家庭成员的健康和医疗保健联系起来。只有当我有足够的时间进行新的培训和研究时，这些项目才是可行的，K01基金将提供这些时间。