The Role of Ambulatory Care in Reducing the Burden of Respiratory Failure

项目总结/摘要 需要解决的临床问题：呼吸衰竭每年导致80万人住院， 幸存者处于脆弱状态，其特点是再住院率、残疾率和死亡率很高。到目前为止， 呼吸衰竭结果的改善主要是通过医院干预措施实现的。的 流动护理环境可能是进一步改善发病率的额外机会， 这种疾病导致的死亡率，虽然以前的工作研究这种关系是有限的。的 这项工作的总体假设是，使用门诊护理减少了呼吸衰竭的影响， 两个关键时间点：通过降低高危患者的呼吸衰竭发生率， 幸存者的住院治疗结果。 具体目标：在目标1中，Admon博士将量化个体水平的特征之间的关联， 高危患者的门诊护理使用率和呼吸衰竭发生率。为了实现这一目标，他将 将生存分析应用于关联的住院和门诊医疗保险索赔数据集，同时调整 患者、医院和地区水平的混杂因素。在目标2中，Admon医生将评估出院后是否 呼吸衰竭幸存者的门诊治疗和利用影响再入院率。到 评估这一点，他将应用现代流行病学方法，以独特的，纵向调查数据，在卫生 和与医疗保险索赔相关的退休研究。最终，实现这些目标将奠定基础 为后续工作开发一种基于门诊护理的干预措施，以减少呼吸系统疾病的影响， 失败 奖学金培训计划和环境：Admon博士的长期目标是成为一名独立的 通过重症监护健康改善呼吸衰竭患者护理的医生-科学家 服务研究。拟议的奖学金将支持这一目标，使他能够从事密集的 指导研究，教学课程和策划的发展活动，所有这些都是在咨询他的 导师，以支持他的特定学术目标。在这样做的过程中，他将建立一个坚实的基础， 发展先进的统计和流行病学方法、纵向调查数据方面的专业知识， 流动索赔。他的导师在帮助初级教师实现独立方面经验丰富 学术生涯，并亲自致力于支持他的学术和专业成长。

PROJECT SUMMARY/ABSTRACT Clinical Problem to be Addressed: Respiratory failure leads to 800,000 hospitalizations per year and leaves survivors in a vulnerable state marked by high rates of rehospitalization, disability, and death. To date, improvements in respiratory failure outcomes have come largely through hospital-based interventions. The ambulatory care environment may represent an additional opportunity to further improve rates of morbidity and mortality stemming from this disease, though prior work examining this relationship has been limited. The overall hypothesis of this work is that the use of ambulatory care reduces the impact of respiratory failure at two key time points: by reducing rates of respiratory failure among patients at risk and by improving post- hospitalization outcomes among survivors. Specific Aims: In aim 1, Dr. Admon will quantify the individual-level association between characteristics of ambulatory care use and rates of respiratory failure among patients at risk. In order to accomplish this, he will apply survival analysis to a dataset of linked inpatient and outpatient Medicare claims while adjusting for patient, hospital, and region-level confounders. In aim 2, Dr. Admon will evaluate whether post-discharge ambulatory care access and utilization influence rates of readmission among survivors of respiratory failure. To assess this, he will apply modern epidemiological methods to the unique, longitudinal survey data in the Health and Retirement Study with linked Medicare claims. Ultimately, accomplishing these aims will lay the foundation for subsequent work developing an ambulatory care-based intervention that reduces the impact of respiratory failure. Fellowship Training Plan and Environment: Dr. Admon’s long-term goal is to become an independent physician-scientist who improves the care of patients with respiratory failure through critical care health services research. The proposed fellowship will support this goal by allowing him to engage in intensive mentored research, didactic coursework, and curated development activities, all chosen in consultation with his mentors to support his particular academic goals. In doing so, he will build on a strong foundation by developing expertise in advanced statistical and epidemiological methods, longitudinal survey data, and ambulatory claims. His mentors are experienced in helping junior faculty members achieve independent academic careers and are personally committed to supporting his academic and professional growth.