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

项目总结 最近在危重病人的急性护理方面的改进带来了新的挑战 危重疾病后持续严重器官衰竭患者的管理。 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，并与巨大的临床和经济负担有关。一 这种干预是决定放置胃造瘘管，以便提供长期的 不能安全地自行摄取足够营养的患者的人工营养 到新的功能状态、精神状态和呼吸功能缺陷。但是，基本的 了解胃造口术的流行病学、胃造瘘术的驱动因素和造口术后的结果 缺乏安置。例如，目前尚不清楚患者重新入院或就诊的频率。 在急诊室放置后，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瘘管的发生率。 1993-2012年间美国危重病人跨年龄组的安置， 描述患者和医院在胃造瘘管放置方面的实践变化， 并描述胃造瘘管放置后患者水平结果的决定因素。我们 假设危重疾病期间胃造瘘管放置情况自1993年以来有所增加 在2000年代末，所有年龄段的人，他们现在构成了主要的 老年人中接受喂养管的住院患者的比例；我们还假设 在危重人群中胃造瘘管的使用在医院层面各不相同。最后，我们 进一步假设多个决定因素，包括年龄、危重前疾病的脆弱程度和 急性危重病的特征可以用来预测并发症的发生率。结果是 将大大促进我们对目前使用胃造瘘管的 危重患者也可以确定长期治疗可能受益最大的患者群体 人工营养。我们的总目标是为构建共同的未来提供必要的基础- 可供危重患者及其代理决策者使用的决策工具 和临床医生帮助决定胃造瘘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，该原则 调查员将完成流行病学理学硕士学位，以获得必要的 流行病学、生物统计学和卫生服务研究技能。这项研究项目将是 在两名具有管理专业知识的卫生服务调查人员的指导下执行 大型行政数据库以及两位老龄化研究专家的建议。 好了！

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. !