Defining Optimal Clinical Strategies for Critically Ill Heart Failure Patients

为危重心力衰竭患者制定最佳临床策略

• 批准号: 9047300
• 负责人: Tara C Lagu
• 金额: $ 16.36万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9047300
• 关键词: Accounting; Admission activity; Adrenergic beta-Antagonists; Affect; Age; American; Cardiovascular system; Caring; Catheters; Characteristics; Clinical; Code; Collaborations; Critical Care; Critical Illness; Data; Data Set; Databases; Development; Diagnosis; Diagnostic; Diastolic heart failure; Diuretics; Environmental air flow; Etiology; Evidence based practice; Faculty; Future; Goals; Health; Heart; Heart failure; Heterogeneity; Hospital Mortality; Hospital Personnel; Hospitalization; Hospitals; Internist; Interview; Intravenous; Lead; Link; Massachusetts; Mechanical ventilation; Medical center; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; Observational Study; Oral; Organ; Outcome; Patient Care; Patients; Peer Group; Performance; Pharmaceutical Preparations; Population; Process; Published Comment; Pulmonary artery structure; Qualitative Methods; Quality of Care; Questionnaires; Records; Reducing Agents; Reporting; Research; Research Personnel; Research Proposals; Research Training; Resources; Risk; Risk Factors; Sample Size; Sampling; Severities; Subgroup; Supportive care; Systolic heart failure; Testing; Time; Training; Tube; Universities; Validation; Variant; Vasoconstrictor Agents; Wood material; Work; aged; base; billing data; clinical practice; cohort; comparative; cost; endotracheal; evidence base; experience; human old age (65+); improved; improved outcome; informant; interest; medical schools; member; mortality; pressure; professor; response; senior faculty; skills

DESCRIPTION (provided by applicant): This is a resubmission application for a K01 award for Tara Lagu, MD, MPH, a board-certified internist and Assistant Professor at the Tufts University School of Medicine. Dr. Lagu is based in the Center for Quality of Care Research (CQCR) at Baystate Medical Center (BMC) in Springfield, Massachusetts. Dr. Lagu's focus is on the quality and outcomes of care for patients with heart failure (HF). Her long-term goal is to become an independent cardiovascular outcomes researcher. Her immediate goals are 1) to use quantitative and qualitative methods to define optimal clinical strategies for the care of critically ill patients with HF and 2) to develop, through mentorship and formal coursework, skills that will help her to become an independent investigator. Her training as a Robert Wood Johnson Clinical Scholar and experience as a young faculty member at BMC will help her to accomplish these goals. Dr. Lagu has assembled a mentorship team with expertise in both the proposed work and in helping junior faculty transition to independence. Her primary mentor is Dr. Peter Lindenauer. Her co-mentor is Dr. Harlan Krumholz. Consultants include Dr. Penelope Pekow (biostatistician) and Dr. Kathleen Mazor (psychometrician). Dr. Lagu will have full access to the resources of both BMC and Tufts University School of Medicine. The CQCR (directed by Dr. Lindenauer, in collaboration with a group of senior faculty), which will provide mentorship, biostatistical, and administrative support as well as a peer group of junior faculty with similar interests. This research proposal aims to answer the question: "What are the clinical strategies that enable hospitals to achieve lower risk-adjusted mortality rates for critically ill patients wih HF?" Critically ill HF patients have a 30-day mortality rate as high as 20%, indicating that these patients contribute disproportionately to reported hospital variation in HF risk adjusted mortality rates, yet there are no large observational studies of these patients. We will first develop a mortality prediction method for use in observational studies of critically ill HF patients that taks advantage of a unique and powerful dataset. In response to reviewer comments, we have included markers of HF etiology in this model and will separately validate the model in subgroups with known HF etiology. Next, we will examine variation in risk-adjusted mortality and will determine the proportion of variation that can be explained by differences in use of evidence-based clinical practices. Because we anticipate that most of the observed variation in risk-adjusted outcomes will remain unexplained, in Aim 3 we will develop qualitative methods that can be used to identify the clinical strategies and practices employed by hospitals with low risk-adjusted mortality rates for this population. These methods will generate preliminary data for an R01 that will include qualitative interviews from many more hospitals and will validate the hypotheses through a random sample questionnaire linked to hospital performance.

描述(由申请人提供)：这是为塔夫茨大学医学院董事会认证的内科医生和助理教授塔拉·拉古，医学博士，公共卫生硕士重新提交的K01奖项的申请。拉古博士在马萨诸塞州斯普林菲尔德的贝州医疗中心(BMC)的医疗质量研究中心(CQCR)工作。拉古博士的重点是心力衰竭(HF)患者的护理质量和结果。她的长期目标是成为一名独立的心血管结果研究人员。她的近期目标是：1)用定量和定性的方法来确定治疗心力衰竭危重病人的最佳临床策略；2)通过指导和正规的课程学习，培养技能。 这将有助于她成为一名独立调查员。她作为罗伯特·伍德·约翰逊临床学者所受的训练和作为BMC年轻教员的经验将帮助她实现这些目标。拉古博士组建了一支导师团队，他们在拟议的工作和帮助初级教员过渡到独立工作方面都有专业知识。她的主要导师是彼得·林德诺博士。她的共同导师是哈兰·克鲁姆霍尔茨博士。顾问包括佩内洛普·佩科博士(生物统计学家)和凯瑟琳·马佐博士(心理测量学家)。拉古博士将完全使用BMC和塔夫茨大学医学院的资源。CQCR(由Lindenauer博士指导，与一群资深教员合作)，将提供指导、生物统计学和行政支持，以及具有相似兴趣的初级教员的同龄人小组。这项研究计划旨在回答这样一个问题：“有哪些临床策略能够使医院降低心力衰竭危重患者的风险调整死亡率？”危重心力衰竭患者30天的死亡率高达20%，这表明这些患者对医院报告的心力衰竭风险调整后死亡率的差异有不成比例的贡献。 然而，目前还没有关于这些患者的大型观察性研究。我们将首先开发一种死亡率预测方法，用于危重心力衰竭患者的观察性研究，该方法利用了独特而强大的数据集。为了回应评论者的意见，我们在这个模型中加入了心力衰竭病因的标记物，并将在已知心力衰竭病因的亚组中单独验证该模型。接下来，我们将检查风险调整死亡率的差异，并确定可以通过循证临床实践的使用差异来解释的差异比例。由于我们预计大多数观察到的风险调整后结果的差异仍将无法解释，在目标3中，我们将开发定性方法，可用于确定该人群风险调整死亡率较低的医院所采用的临床策略和做法。这些方法将为R01生成初步数据，其中将包括来自更多医院的定性访谈，并将通过与医院绩效相关的随机抽样问卷来验证假设。