Longitudinal Patterns of Symptoms, Medication and Hospice Use in Nursing Home Residents Approaching End of Life

临终疗养院居民的症状、药物治疗和临终关怀使用的纵向模式

• 批准号: 10662447
• 负责人: JENNIFER TJIA
• 金额: $ 19.84万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662447
• 关键词: Address; Admission activity; Adverse event; Affect; Aging; American; American Cancer Society; Analgesics; Antibiotics; Anticoagulants; Antidepressive Agents; Anxiety; Area; Attention; Benefits and Risks; Caring; Certification; Cessation of life; Characteristics; Clinical; Clinical Research; Clinical Sciences; Data; Data Reporting; Data Set; Dedications; Dementia; Development; Discipline; Diuretics; Elderly; Enrollment; Explosion; Foundations; Frail Elderly; Fraud; Funding; Geography; Geriatrics; Goals; Growth; Health system; Hospice Care; Individual; Institute of Medicine (U.S.); Institutionalization; Interview; Length of Stay; Life; Life Expectancy; Link; Marketing; Massachusetts; Measures; Medicare; Mentors; Mentorship; Methods; Modeling; Nursing Homes; Pain Measurement; Palliative Care; Palliative Medicine; Patients; Pattern; Performance; Pharmaceutical Preparations; Pharmacoepidemiology; Physician Executives; Play; Policies; Polypharmacy; Population; Prognosis; Provider; Qualitative Methods; Quality of life; Randomized, Controlled Trials; Reporting; Research; Research Activity; Research Personnel; Research Support; Resources; Risk; Role; Schools; Science; Services; Site; Surveys; Symptoms; Training; Training Support; Translational Research; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; Universities; Vulnerable Populations; Work; care delivery; career; career development; clinical candidate; clinical center; clinically relevant; cost; data resource; design; end of life; evidence base; experience; graduate school; hospice environment; hypnotic; improved; informant; innovation; medical schools; meetings; multidisciplinary; palliative; patient oriented research; payment; population based; population health; programs; quality of death; recruit; skills; symptomatic improvement; therapy development; tool

LONGITUDINAL PATTERNS OF SYMPTOMS, MEDICATION AND HOSPICE USE IN NURSING HOME RESIDENTS APPROACHING END OF LIFE The candidate’s long-term career objective is to make a sustained impact as a geriatric palliative care research leader by mentoring promising, multidisciplinary investigators in aging research. The candidate’s professional life has been dedicated to the conduct of patient-oriented research in geriatric pharmacoepidemiology for nursing home and hospice patients, focusing specifically on the topic of deprescribing. Establishing the evidence for the risks and benefits of prescribing and deprescribing decisions, and identifying which patients will receive the greatest benefit from deprescribing based on a shift from curative to symptom-oriented care, is challenging. Institutionalized frail older adults are a particularly vulnerable population because of their high burden of polypharmacy, risk of medication-related adverse events, limited life expectancy, and lack of randomized controlled trial data for medication efficacy. Training a multidisciplinary group of junior investigators is key to building the deprescribing evidence base. Studies are needed that can ultimately inform the design of tools that identify when nursing home residents are entering the final stages of their life and the development of interventions to optimize medication use when that happens. Thus, the objectives of this K24 are: 1. To enhance the candidate’s capacity to effectively mentor a multidisciplinary group of mentees in patient-oriented research, and 2. To expand the candidate’s clinical research program in geriatric palliative care and deprescribing in directions that create new and innovative opportunities for mentees, including qualitative methods for mixed-methods studies. This will be accomplished by: i. recruitment of promising mentees from varied disciplines committed to aging research, ii. individual mentorship of these trainees in their research activities and career development, and iii. didactic sessions and formal coursework for mentees. The candidate’s research brings together expertise in geriatrics and aging research, palliative medicine and hospice care, and pharmacoepidemiology. The candidate’s research program about nursing home residents and hospice enrollees grows out funding from the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Cancer Society and the Donoghue Foundation. These studies have contributed to the creation of rich data resources that will be used by mentees, including a nationwide dataset of all nursing home residents from 2011-2016 that links the Minimum Data Set 3.0 to Medicare Part D data, Certification and Survey Provider Enhanced Reporting data, Area Resource Files and Medicare Hospice Utilization Public Use Files. Resources supporting training, development, and execution of the proposed research include the University of Massachusetts Medical School’s (UMMS) Center for Clinical and Translational Science, UMMS’ Graduate School of Biomedical Sciences, UMMS’ Clinical and Population Health Research program, and the UMMS’ Quantitative Methods Core.

疗养院症状、用药和临终关怀使用的纵向模式 居民生命接近尾声 候选人的长期职业目标是作为老年姑息治疗研究产生持续的影响 通过指导有前途的多学科研究人员在老龄化研究中发挥带头作用。候选人的专业人士 LIFE一直致力于开展以患者为导向的老年药物流行病学研究 疗养院和临终关怀病人，特别关注停药的主题。建立 开处方和停开处方决定的风险和好处的证据，以及确定哪些患者 将从基于从治疗转向以症状为导向的护理的停药中获得最大的好处，是 很有挑战性。住院的虚弱老年人是一个特别脆弱的群体，因为他们的高 多药联用的负担、与药物相关的不良事件的风险、有限的预期寿命以及缺乏 药物疗效的随机对照试验数据。培训一组多学科的初级调查员 是建立停药证据库的关键。需要研究，以最终为设计提供信息 确定疗养院居民何时进入其生活和发展的最后阶段的工具 当这种情况发生时，采取干预措施优化药物使用。因此，本K24的目标是：1. 提高候选人在以病人为中心的指导下有效指导多学科受训者的能力 研究，以及2.扩大候选人在老年姑息治疗和临床研究方面的计划 在为学员创造新的创新机会的方向上取消处方，包括质量 方法：采用混合方法研究。这将通过以下方式实现：一、从以下方面招聘有前途的学员 致力于老龄化研究的不同学科，2。对这些受训人员进行研究的个人指导 活动和职业发展，以及3.为学员提供授课课程和正式课程。这个 候选人的研究汇集了老年病学和衰老研究、姑息医学和 临终关怀和药物流行病学。候选人关于养老院居民的研究计划 临终关怀登记人员的资金来自国家卫生研究院，即医疗保健机构 研究和质量，美国癌症协会和多诺霍基金会。这些研究已经 帮助创建了丰富的数据资源，供学员使用，包括全国性的数据集 在2011-2016年间将最低数据集3.0与联邦医疗保险D部分数据联系起来的所有疗养院居民中， 认证和调查提供商增强的报告数据、区域资源文件和联邦医疗保险临终关怀 利用率公共使用文件。支持培训、开发和执行计划的资源 研究包括马萨诸塞大学医学院(UMMS)临床和 翻译科学，密歇根州立大学生物医学研究生院，密歇根州立大学临床与人口 健康研究计划和UMMS的量化方法核心。

项目成果

Association of Advance Care Planning Visits With Intensity of Health Care for Medicare Beneficiaries With Serious Illness at the End of Life.

• DOI: 10.1001/jamahealthforum.2021.1829
• 发表时间: 2021-07
• 期刊: JAMA health forum
• 作者: Weissman JS;Reich AJ;Prigerson HG;Gazarian P;Tjia J;Kim D;Rodgers P;Manful A
• 通讯作者: Manful A

Advance Care Planning for Spanish-Language Speakers: Patient, Family, and Interpreter Perspectives.

• DOI: 10.1177/07334648231156864
• 发表时间: 2023-08
• 期刊: JOURNAL OF APPLIED GERONTOLOGY
• 影响因子: 3
• 作者: Puerto, Geraldine;Chiriboga, German;DeSanto-Madeya, Susan;Duodu, Vennesa;Cruz-Oliver, Dulce M.;Tjia, Jennifer
• 通讯作者: Tjia, Jennifer