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）：本申请是为凯瑟琳·奥恩斯坦（Katherine Ornstein）的指导研究科学家发展奖（K01），博士，西奈山伊坎医学院的老年医学和姑息医学讲师。我建议在五个领域发展专业知识，这将使我能够对终止护理对家庭网络的下游影响进行研究：1）数据链接； （2）患有严重疾病的老年人面临的经济和政策问题，包括在生命结束时提供医疗保健提供和治疗的知识； （3）索赔数据的成本分析和使用； （4）分析复杂的纵向调查； （5）社交网络分析。在我的指导团队的指导下，由西奈山（Mount Sinai）的Brookdale老年医学和姑息医学系教授兼董事长Albert Siu，MD MSPH主席，我将使用这些培训领域获得的技能开始 为了填补我们对生命终止强度如何通过三个研究项目影响家庭的杰出空白，K01将使我保护研究时间。对于痴呆症等严重疾病的老年患者的生命终结护理通常包括高强度治疗，可能是繁重且昂贵的。我们对这些治疗方法如何影响患者的健康和医疗保健利用的理解在患者的发展前后都是有限的。当前的终身医疗保健成本估算不考虑与关心认真生病亲人的家庭成员的医疗支出相关的潜在下游成本。首先，我将研究生命终止治疗对人力资源管理队队的纵向调查数据死亡后，生命治疗终止对配偶医疗保健支出的差异影响以及来自医疗保健达特茅斯（Dartmouth）医疗保健达特茅斯（Dartmouth Atlas of Healthcare）的单个医疗保险索赔和区域数据的纵向调查数据（AIM 1）。接下来，我将使用来自HRS的数据，临床痴呆症患者及其护理人员的数据来确定终阶段痴呆症患者的医疗保健治疗强度与护理人员的医疗保健支出之间的关联（AIM 2）。最后，我将使用丹麦人口注册表数据（AIM 3）来表征患者死亡之前和之后配偶的医疗保健利用轨迹。除这些研究目的外，我的K01奖励期还将着重于准备R01赠款提案，以将死者的医疗保健利用与使用人群注册表的所有成年家庭成员的健康和医疗保健联系起来。这些项目只有在我保护了新的培训和研究的时间时才可行，K01资金将提供。