The role of physician experience in outcomes of patients with acute respiratory f

描述（由申请人提供）：需要机械通气的急性呼吸衰竭患者有很高的发病率和死亡率。尽管最近的一些进展改善了对这类患者的管理，但这些治疗方法尚未被完全采用，各医院的患者预后仍各不相同。可能与改进证据转化为实践相关的一个因素是医师提供者的经验。先前的研究间接地为这种关系提供了证据；例如，较高的年度住院人数与较低的死亡率有关。然而，几乎没有直接的证据，医生的“经验”也没有被定义，组织解决方案的能力来改变这种关系是未知的。更好地理解这种复杂的关系可以揭示新的干预目标，以提高机械通气患者的循证实践的吸收，并最终改善他们的结果。因此，本提案的总体目标是了解医生经验与机械通气患者预后之间的关系。具体而言，我们将确定(1)医师经验（定义为完成培训后的年数）与患者预后是否存在关联；(2)医生经验和医院数量对患者预后的相对贡献；(3)医师经验的影响是否受到组织因素的影响。在这个项目中，我们将创建一个创新的数据库，将宾夕法尼亚州住院患者的多个公开可用的管理和临床数据集与从全州医院调查中获得的数据联系起来，并将使用最先进的统计建模技术来提高我们对医生在患者结果中的作用的理解。该数据库和职业发展奖将为候选人未来作为独立临床研究人员的工作奠定基础，重点是开发和实施有组织的干预措施，以改善急性呼吸衰竭患者的护理。Meeta Prasad Kerlin博士拥有肺和重症监护医学的临床背景，并获得宾夕法尼亚大学临床流行病学硕士学位。她通过成功完成了几个关于重症监护结果和教育的研究项目，展示了她对临床研究的兴趣和才能。她曾在JAMA和Critical Care Medicine等高影响力期刊上发表多篇文章。在这份计划书中，她制定了一份职业发展计划，其中包括教学式学习、结构化专业发展、密集指导和领导上述项目的直接研究经验的补充方法。她得到了她所在院系的全力支持，以及在重症监护结果研究方面已经处于领先地位的杰出导师，并获得了宾夕法尼亚大学的大量资源。总之，这些将确保她成功地发展成为她自己的领导者。

DESCRIPTION (provided by applicant): Patients with acute respiratory failure requiring mechanical ventilation are at high risk for morbidity and mortality. Although several recent advances have improved management of such patients, these therapies have been incompletely adopted and patient outcomes continue to vary across hospitals. One factor that may be associated with improved translation of evidence into practice is the experience of the physician provider. Previous studies indirectly provide evidence for this relationship; for example, higher annual hospital volume is associated with reduced mortality. However, there is little direct evidence, physician "experience" has not been defined, and the capacity of organizational solutions to modify the relationship is unknown. A better understanding of this complex relationship could reveal novel targets for interventions to improve uptake of evidence-based practices of mechanically ventilated patients and ultimately their outcomes. Therefore the overall goal of this proposal is to understand the relationship between physician experience and outcomes for mechanically ventilated patients. Specifically, we will determine (1) if there is an association of physician experience, defined as years since completing of training, with patient outcomes; (2) the relative contributions of physician experience and hospital volume to patient outcomes; and (3) if effects of physician experience are modified by the presence of organizational factors. For this project we will create an innovative database linking multiple publicly available administrative and clinical datasets of patients hospitalized in the state of Pennsylvania with data obtained from a state-wide hospital survey and will use state-of-the-art statistical modeling techniques to advance our understanding of the role of the physician in patient outcomes. This database and career development award will be a foundation for the candidate's future work as an independent clinical researcher with a focus on developing and implementing organizational interventions to improve care of patients with acute respiratory failure. Dr. Meeta Prasad Kerlin has a clinical background in pulmonary and critical care medicine and a Master of Science in Clinical Epidemiology from the University of Pennsylvania. She has demonstrated her interest and aptitude for clinical research through the successful completion of several research projects in the topics of critical care outcomes and education. She has had multiple publications in high-impact journals such as JAMA and Critical Care Medicine. In this proposal, she has developed a career development plan that includes a complementary approach of didactic learning, structured professional development, intensive mentorship, and direct research experience leading the project described above. She has the full support of her department, outstanding mentors who are already the leaders in critical care outcomes research, and access to the vast resources of the University of Pennsylvania. Together, these will ensure her successful development into a leader in her own right.