Optimizing treatment for nursing home residents with acute cholecystitis

优化疗养院居民急性胆囊炎的治疗

• 批准号: 9027788
• 负责人: Emily Finlayson
• 金额: $ 32.49万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-15 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9027788
• 关键词: Abdomen; Acute Cholecystitis; Aftercare; Age; Antibiotic Therapy; Benefits and Risks; Cessation of life; Characteristics; Cholecystectomy; Cholecystostomy; Cholelithiasis; Cognitive; Comorbidity; Data; Data Set; Decision Making; Diagnosis; Disease; Drainage procedure; Effectiveness; Elderly; Future; Gall Bladder Diseases; Gallbladder; Geographic Locations; Health; Health Personnel; Home Nursing Care; Hospitalization; Individual; Infection; Knowledge; Life Expectancy; Medicare claim; Nursing Homes; Operative Surgical Procedures; Outcome; Patients; Pattern; Physicians; Population; Provider; Recurrence; Recurrent disease; Research; Risk; Safety; Subgroup; Therapeutic; Time; Treatment outcome; Tube; United States; Variant; Vulnerable Populations; Work; alternative treatment; base; clinical decision-making; common treatment; experience; functional decline; functional outcomes; functional status; gastrointestinal; high risk; hospital readmission; improved; individualized medicine; innovation; medical specialties; mortality; nursing home length of stay; operation; standard of care; treatment choice; treatment strategy

DESCRIPTION (provided by applicant): Acute cholecystitis - infection of the gallbladder - is one of the most common gastrointestinal conditions in the United States. Removal of the gallbladder (cholecystectomy) is the only definitive treatment for acute cholecystitis. More than a third of patients with acute cholecystitis who do not undergo surgery will experience gallstone-related complications within 2 years of initial diagnosis. For this reason, cholecystectomy at the time of initial episode is considered the standard of care. Whether the risks of surgery are lower than the burdens of recurrent disease in patients with limited life-expectancy is unclear. Surgical decision-making for elder nursing home residents is challenging. Our overarching research objective is to improve care for nursing home residents by providing them and their health care providers realistic information about risks and benefits of treatment for common surgical diseases. For some conditions that are usually treated surgically, the risks of surgery for nursing home residents may outweigh the burdens of future disease complications that may never occur during their remaining lifetime. Nonsurgical therapies such as percutaneous gallbladder drainage or antibiotic therapy alone may be more appropriate. The objective of the proposed study is to better understand the use and outcomes of surgery and nonsurgical therapy to treat acute cholecystitis in elder nursing home residents. To inform nursing home residents and their health care providers about risks and benefits of different treatment strategies our project has three specific aims: [1) To evaluate current treatments for acute cholecystitis among nursing home residents and determine resident and provider characteristics associated with the use of cholecystectomy and nonsurgical treatment, 2) to identify determinants of short term outcomes after surgery and nonsurgical treatment among nursing home residents with acute cholecystitis and compare the outcomes of residents undergoing surgical v nonsurgical treatment and 3) to determine the association between resident and provider characteristics and longitudinal functional outcomes, survival, and recurrent gallbladder disease after initial treatment for acute cholecystitis and compare longitudinal outcomes of residents undergoing surgical and nonsurgical treatment. The approach is innovative because, in addition to comorbidity, we will evaluate the impact of cognitive and functional status - important and powerful predictors of life expectancy - on treatment choice and outcomes for acute cholecystitis in the entire nursing home population age 65 and older in the United States. This study is significant because currently there is no information about treatment and outcomes for this common disease in this large and vulnerable population. For individuals with limited life expectancy, determining the individualized treatment that alleviates suffering and best maintain function is essential. Better knowledge of the safety and effectiveness of alternative treatment strategies in subgroups of nursing home residents will minimize the harm of both under-treatment and overtreatment of this common disease.

描述（由申请人提供）：急性胆囊炎（胆囊感染）是美国最常见的胃肠道疾病之一。胆囊切除术（胆囊切除术）是急性胆囊炎的唯一确定性治疗方法。超过一个 三分之一未接受手术的急性胆囊炎患者将在初次诊断后 2 年内出现胆结石相关并发症。因此，初次发作时的胆囊切除术被认为是标准治疗。对于预期寿命有限的患者，手术风险是否低于复发性疾病的负担尚不清楚。外科 老年疗养院居民的决策具有挑战性。我们的总体研究目标是通过向疗养院居民及其医疗保健提供者提供有关常见外科疾病治疗的风险和益处的真实信息来改善对疗养院居民的护理。对于一些通常通过手术治疗的病症，手术护理的风险 家庭居民的负担可能会超过未来疾病并发症的负担，而这些并发症在他们的余生中可能永远不会发生。非手术治疗，如经皮胆囊引流或单独抗生素治疗可能更合适。拟议研究的目的是更好地了解手术和非手术疗法治疗老年疗养院居民急性胆囊炎的使用和结果。为了让疗养院居民及其医疗保健提供者了解不同治疗策略的风险和益处，我们的项目有三个具体目标：[1) 评估疗养院居民目前对急性胆囊炎的治疗方法，并确定与使用胆囊切除术和非手术治疗相关的居民和提供者特征，2) 确定急性胆囊炎疗养院居民手术和非手术治疗后短期结果的决定因素。 胆囊炎并比较接受手术与非手术治疗的居民的结果，3) 确定居民和提供者特征与急性胆囊炎初始治疗后纵向功能结果、生存和复发性胆囊疾病之间的关联，并比较接受手术和非手术治疗的居民的纵向结果。 该方法具有创新性，因为除了合并症之外，我们还将评估认知和功能状态（预期寿命的重要而有力的预测因素）对美国所有疗养院 65 岁及以上人群的急性胆囊炎治疗选择和结果的影响。这项研究意义重大，因为目前尚无关于这一庞大易感人群中这种常见疾病的治疗和结果的信息。对于预期寿命有限的个体来说，确定减轻痛苦并最好地维持功能的个体化治疗至关重要。更好地了解疗养院居民亚群替代治疗策略的安全性和有效性，将最大限度地减少这种常见疾病治疗不足和过度治疗的危害。