Improving patient- and family-centered outcomes and value of care for patients with chronic illness who develop acute respiratory failure

改善发生急性呼吸衰竭的慢性病患者的以患者和家庭为中心的结果和护理价值

• 批准号: 9980486
• 负责人: Nita Khandelwal
• 金额: $ 19.02万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980486
• 关键词: Acute respiratory failure; Address; Adult; Anesthesiology; Biomedical Research; Biometry; Caring; Child; Chronic; Chronic Disease; Clinical Research; Clinical Trials; Clinical and Translational Science Awards; Complex; Critical Illness; Data; Development; Development Plans; Electronic Health Record; Environment; Evaluation; Family; Family member; Feedback; Financial Hardship; Funding; Future; Goals; Grant; Health; Healthcare; Hospitals; Institutes; Institution; Intensive Care; Intensive Care Units; Intervention; Interview; Knowledge; Lead; Life; Link; Longitudinal cohort study; Measures; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Outcome; Pain; Palliative Care; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Physicians; Population; Public Health Schools; Qualitative Methods; Records; Reporting; Research; Research Personnel; Research Proposals; Research Training; Resources; Retrospective cohort; Risk; Role; Scientist; Socioeconomic Status; Statistical Methods; Structure; Supportive care; Time; Training; Universities; Vulnerable Populations; Washington; Work; care costs; career; career development; cognitive disability; cost; design; experience; frailty; functional disability; functional status; high risk; improved; improved outcome; innovation; interest; novel; palliative; patient oriented research; physically handicapped; programs; psychological distress; psychological symptom; skill acquisition; skills; success; therapy design; translational health science

PROJECT SUMMARY/ABSTRACT Candidate: This K23 award will provide an opportunity for Dr. Khandelwal to achieve her long-term goal of being an independently funded physician scientist with a focus on improving patient- and family-centered outcomes for patients with acute respiratory failure (ARF) and their family members. Through this proposal, Dr. Khandelwal will achieve her immediate goals of acquiring: 1) expertise in the evaluation of patient-and family-reported outcomes, use of qualitative methods to inform the development and assessment of interventions, and training in advanced multi-level statistical methods and clinical trials; and 2) pilot data and skills to successfully apply for R level grants that include clinical trials and longitudinal cohort studies. These objectives will be achieved through a career development plan that incorporates formal coursework, skilled mentoring, and protected time to gain research experience in an outstanding environment. Research: In this patient-oriented research proposal, Dr. Khandelwal will identify patients with ARF and chronic illness who are at greatest risk for poor outcomes (psychological distress, functional impairment, financial stress), and the types of supportive and palliative interventions that would be most helpful in improving these outcomes. To accomplish this, she will: 1) identify predictors of poor patient and family outcomes, including number and type of chronic conditions, measures of frailty, and prior healthcare use; 2) identify predictors of high hospital and ICU utilization and costs; and 3) explore patient, family, and clinician perspectives on the types, timing, and feasibility of supportive and palliative interventions that they believe would improve these outcomes. To date, attempts to improve patient or family outcomes have been disappointing and suggest the need for interventions targeted to specific populations and specific needs. Findings from these aims will result in innovative interventions for patients with ARF who are at greatest risk for poor outcomes and potentially burdensome, costly care. By efficiently targeting supportive and palliative care resources to those who need and may benefit most, this study has the potential to improve value-driven care to this vulnerable population. Environment: The University of Washington (UW) is an ideal setting for Dr. Khandelwal's research training. UW is an outstanding biomedical research institution with a strong commitment to promoting the academic careers of promising investigators. The UW Department of Anesthesiology & Pain Medicine is widely recognized for its support of early career physician scientists in development of the skills necessary to achieve academic success. In addition to the resources provided within her Department, Dr. Khandelwal will also have the full support of the Cambia Palliative Care Center of Excellence at UW (directed by her primary mentor) and will have access to clinical research and biostatistical support through the UW School of Public Health and the Institute of Translational Health Sciences (the Clinical and Translational Science Award program at UW).

项目总结/摘要 候选人：这个K23奖将为Khandelwal博士实现她的长期目标提供一个机会， 作为一名独立资助的医生科学家，专注于改善以患者和家庭为中心的 急性呼吸衰竭（ARF）患者及其家属的结局。通过这一提议， 博士Khandelwal将实现她的直接目标，即获得：1）评估患者的专业知识， 家庭报告的结果，使用定性方法为发展和评估提供信息， 干预措施，并在先进的多层次统计方法和临床试验的培训;和2）试点数据和 成功申请R级赠款的技能，包括临床试验和纵向队列研究。这些 目标将通过职业发展计划来实现，该计划包括正式的课程，熟练的 指导，并保护时间，以获得研究经验，在一个优秀的环境。 研究：在这项以患者为导向的研究提案中，Khandelwal博士将识别ARF患者， 慢性病患者预后不良的风险最大（心理困扰，功能障碍， 财务压力），以及最有助于 改善这些成果。为了实现这一目标，她将：1）确定贫困患者和家庭的预测因素 结果，包括慢性疾病的数量和类型、虚弱程度和既往医疗保健使用情况; 2） 确定高医院和ICU利用率和成本预测因素; 3）探索患者、家庭和临床医生 对他们认为的支持性和姑息性干预措施的类型、时机和可行性的看法 将改善这些结果。到目前为止，改善患者或家庭结局的尝试已经被证明是可行的。 这表明需要针对特定人群和特定需求采取干预措施。 这些目标的发现将为ARF风险最大的患者提供创新的干预措施 不良结果和潜在的负担，昂贵的护理。通过有效地针对支持和姑息治疗 资源给那些需要和可能受益最多的人，这项研究有可能改善价值驱动的护理， 这个弱势群体。 环境：华盛顿大学（UW）是Khandelwal博士研究培训的理想环境。 UW是一个杰出的生物医学研究机构，致力于促进学术 有前途的调查员的职业生涯。UW麻醉学与疼痛医学系广泛 承认其支持早期职业医生科学家在发展必要的技能，以实现 学术上的成功除了她所在部门提供的资源外，Khandelwal博士还将拥有 坎比亚姑息治疗卓越中心在华盛顿大学的全力支持（由她的主要导师指导）， 将有机会获得临床研究和生物统计支持，通过公共卫生的UW学校和 转化健康科学研究所（临床和转化科学奖计划）。