Trends, Practice Variations, and Outcomes of Gastrostomy Tubes Placed during Critical Illness in the United States

美国危重疾病期间放置胃造口管的趋势、实践变化和结果

• 批准号: 9465839
• 负责人: Anica C Law
• 金额: $ 8.34万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-01 至 2020-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9465839
• 关键词: Accident and Emergency department; Acute; Address; Age; Aging; Award; Biometry; Caring; Cessation of life; Characteristics; Chronology; Clinical; Critical Care; Critical Illness; Data; Data Set; Decision Making; Dementia; Dialysis procedure; Eating; Elderly; Eligibility Determination; Emergency department visit; Enteral; Enteral Feeding; Epidemiological trend; Epidemiology; Failure to Thrive; Family; Foundations; Future; Gastrostomy; Goals; Guidelines; Health Services; Health Services Research; Hospital Mortality; Hospitals; Incidence; Inpatients; Intensive Care; Intensive Care Units; Intervention; Knowledge; Lead; Life; Longitudinal Studies; Master of Science; Measures; Mechanical ventilation; Medicare; Modeling; Nutritional Support; Organ failure; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Policy Maker; Population; Predictive Factor; Recommendation; Research; Research Personnel; Research Project Grants; Research Training; Respiratory physiology; Risk; Sampling; Severity of illness; Shock; Societies; Subgroup; Survivors; Training; Training Programs; Tube; United States; United States Agency for Healthcare Research and Quality; Variant; Work; administrative database; advanced dementia; age group; clinical decision-making; comorbidity; demographics; experience; frailty; functional status; hospital readmission; individual patient; mental state; mortality; nutrition; older patient; outcome prediction; patient population; patient stratification; shared decision making; skills; surrogate decision maker; survivorship; tool; trend

PROJECT SUMMARY Recent improvements in the acute care of critically ill patients have led to new challenges in the management of patients who survive with persistent, severe organ failure after critical illness. The population of patients requiring long-term life support after critical care is rapidly growing, made up mostly of older adults, and associated with a large clinical and financial burden. One such intervention is the decision to place a gastrostomy tube to allow for provision of long-term artificial nutrition in patients who are unable to safely take in sufficient nutrition on their own due to new deficits in functional status, mental status, and respiratory function. However, basic knowledge of the epidemiology, drivers of gastrostomy use, and outcomes after gastrostomy placement is lacking. It is unknown, for example, how frequently patients are readmitted or seen in the emergency room after placement, or what the rate of mortality is one year after placement. The project proposed here seeks to quantify the incidence of gastrostomy tube placement across age groups in critically ill patients in the United States from 1993-2012, describe patient and hospital drivers of practice variation in the placement of gastrostomy tubes, and describe the determinants of patient-level outcomes after gastrostomy tube placement. We hypothesize that gastrostomy tube placement during critical illness has increased from 1993 through the late 2000s across all age groups, and that they now make up the predominant fraction of hospitalized patients receiving feeding tubes in older adults; we also hypothesize that utilization of gastrostomy tubes in the critically ill population vary at the hospital level. Finally, we hypothesize further that multiple determinants, including age, pre-critical illness frailty, and characteristics of acute critical illness can be used to predict rates of complications. The results will significantly advance our understanding of the current use of gastrostomy tubes among the critically ill as well identify the patient populations that may benefit the most from long-term artificial nutrition. Our overall goal is to provide the necessary foundation for a future shared- decision making tool that can be used by critically ill patients, their surrogate decision makers, and clinicians to help decide whether the likely outcomes of a gastrostomy tube are in line with the patient’s wishes and values. As part of the research training program, the principle investigator will complete a Masters of Science in Epidemiology in order to obtain the necessary epidemiologic, biostatistics, and health services research skills. This research project will be performed under the guidance of two health services investigators with expertise in managing large administrative databases as well as with advice from two experts in research on aging. !

项目概要 危重病人急症护理的最新进展给重症患者带来了新的挑战 对危重病后因持续性严重器官衰竭而幸存的患者进行管理。 重症监护后需要长期生命支持的患者人数正在迅速增长， 主要由老年人组成，并带来巨大的临床和经济负担。一 这种干预措施是决定放置胃造口管以提供长期治疗 对因自身原因无法安全摄入足够营养的患者进行人工营养 功能状态、精神状态和呼吸功能的新缺陷。不过，基本 了解流行病学、胃造口术使用的驱动因素以及胃造口术后的结果 缺乏安置。例如，尚不清楚患者重新入院或就诊的频率 安置后在急诊室，或一年后的死亡率是多少 放置。这里提出的项目旨在量化胃造口管的发生率 1993年至2012年美国不同年龄组的重症患者的安置， 描述患者和医院在放置胃造口管时实践差异的驱动因素， 并描述胃造口管放置后患者水平结果的决定因素。我们 假设自 1993 年以来危重病期间胃造口管置入有所增加 到 2000 年代末，所有年龄段的人都受到影响，现在他们已成为主要的群体 接受饲管的老年人住院患者比例；我们还假设 危重病人胃造口管的使用情况因医院而异。最后，我们 进一步假设多种决定因素，包括年龄、危重病前的虚弱和 急性危重症的特征可用于预测并发症的发生率。结果 将极大地增进我们对胃造口管目前使用情况的了解 危重病人还确定了可能从长期治疗中受益最大的患者群体 人工营养。我们的总体目标是为未来的共享提供必要的基础 可供重症患者及其代理决策者使用的决策工具， 和临床医生帮助确定胃造口管的可能结果是否符合 患者的愿望和价值观。作为研究培训计划的一部分，原则 调查员将完成流行病学理学硕士学位，以获得必要的知识 流行病学、生物统计学和卫生服务研究技能。该研究项目将 在两名具有管理专业知识的卫生服务调查员的指导下进行 大型管理数据库以及两位老龄化研究专家的建议。 ！