Preventing avoidable deaths from pneumonia by improving use of intensive care

项目总结/摘要 候选人的长期职业目标：成为一名独立的调查员和决策科学家， 改善重症监护室（ICU）的临床决策。 需要解决的临床问题：每年有10，000名美国人死于肺炎，但如果他们 在ICU接受治疗。该提案的总体假设是， 那些可以从ICU护理中受益但没有接受ICU护理的患者，这些特征通常不是 纳入ICU护理医生决策的认知模型，即使这些 由于模型是准确的，医院因素阻止了医生提供可能挽救生命的ICU护理。 候选人的背景和成就：托马斯谷博士是一个讲师在肺和重症监护 密歇根大学医学院。他获得了医疗保健研究硕士学位。到目前为止，他 发表了15篇论文，包括9篇原创同行评审研究手稿，其中他是第一作者 5，包括1在JAMA。他赢得了两个试点赠款和NHLBI贷款偿还奖。他所在部门的 对他的坚定承诺包括2018年6月1日被任命为助理教授，无论 这一建议的成果，包括启动一揽子计划，其中包括25万美元的自由裁量研究基金。 职业发展计划：为了实现他的目标，谷博士建议发展新的专业知识， 决策科学通过正式的课程和指导研究。他的主要导师是西奥多 密歇根州的Iwashyna，他指导了5名临床科学家获得K奖，其中2人已经获得R 01 或同等奖励。他是共同指导安吉拉Fagerlin，主席人口健康科学和一个 犹他州的决策科学家和密歇根州ICU组织和政策专家科林·库克。 目的：利用现有数据的二次分析和原始数据收集，他将1）开发和 验证预测模型，以识别应入住ICU但通常 2）根据经验确定医生关于ICU入院的关键决策模型; 3）表征 组织层面的障碍和促进因素，以改善ICU入院实践。 目标的可实现性：拟议的目标将导致4篇新论文，并为Valley博士撰写1篇R21做好准备 1 R 01提案R21将开发和试点一种工具，以确定肺炎患者， ICU护理。R 01将在一项群集随机试验中测试该工具，以改善ICU对肺炎的使用。

PROJECT SUMMARY/ABSTRACT Candidate’s Long-Term Career Goal: To become an independent investigator and decision scientist seeking to improve clinical decision-making in the intensive care unit (ICU). Clinical Problem to be Addressed: Each year, 10,000 Americans die from pneumonia, yet might not if they had received care in the ICU. This proposal’s overall hypothesis is that there are definable characteristics of patients who could benefit from ICU care but do not receive it, that those characteristics are often not incorporated into cognitive models of physician decision-making around ICU care, and that even when those models are accurate, hospital factors prevent physicians from providing potentially life-saving ICU care. Candidate’s Background and Achievements: Dr. Thomas Valley is a Lecturer in Pulmonary and Critical Care Medicine at the University of Michigan. He has earned a Master’s degree in healthcare research. To date, he has published 15 papers, including 9 original peer-reviewed research manuscripts, of which he was first author on 5, including 1 in JAMA. He has won 2 pilot grants and an NHLBI Loan Repayment award. His department’s strong commitment to him includes an appointment as Assistant Professor on June 1, 2018, regardless of the outcome of this proposal, with a start-up package including $250,000 of discretionary research funds. Career Development Plan: In order to achieve his goals, Dr. Valley proposes to develop new expertise in decision science through formal coursework and mentored research. His primary mentor is Theodore Iwashyna at Michigan, who has mentored 5 clinician-scientists on K awards, of whom 2 have already won R01 or equivalent awards. He is co-mentored by Angela Fagerlin, Chair of Population Health Sciences and a decision scientist at Utah, and Colin Cooke, an expert in ICU organization and policy at Michigan. Aims: Using both secondary analysis of existing data and primary data collection, he will 1) develop and validate a prediction model to identify patients with pneumonia who should be admitted to the ICU, but often are not; 2) empirically identify key decision-making models of physicians about ICU admission; and 3) characterize barriers and facilitators at the organizational-level to improving ICU admission practices. Deliverables from Aims: The proposed Aims will lead to 4 new papers and prepare Dr. Valley to write 1 R21 and 1 R01 proposal. The R21 will develop and pilot a tool to identify patients with pneumonia who should receive ICU care. The R01 will test this tool in a cluster randomized trial to improve ICU use for pneumonia.