Characterizing the Impact of Fragmented Care in Acute Respiratory Failure

项目总结/摘要 候选人的长期职业目标：成为一名独立的研究者，使用先进的 观察性研究方法，以改善重症监护的组织和提供。 需要解决的临床问题：急性呼吸衰竭导致2，000，000例住院治疗和400，000例 每年在美国死亡。结果在医院之间差异很大，这表明如何改善 组织和提供护理可改善生存。然而，影响住院护理团队的全球变化 鼓励分散不连续的护理分散在多个医生。很少有人知道如何 分散的护理会影响呼吸衰竭的成年人，以及医院可以做些什么来保护患者免受伤害。 具体目标：使用先进的因果推理方法应用于新的数据源，Admon博士将1） 比较分散护理对院内和院后呼吸衰竭结局的因果影响; 2） 确定特定并发症是否在分散护理中更常发生，并预测更差的结果; 以及3）测试当护理分散时，住院护理的具体特征是否能保护患者免受伤害。 候选人背景：Andrew Admon博士是肺和危重病领域的讲师和研究员。 密歇根大学的护理医学。他在公共卫生和医疗保健方面受过高级培训 research.发表论文25篇，其中原创研究论文17篇， 手稿作为第一作者。Admon博士的工作得到了NHLBI NRSA F32奖的支持。 职业发展计划：为了实现他的长期职业目标，Admon博士寻求深入，重点培训， 因果推理和调查方法。因此，他的5年计划包括策划课程， 他在定量研究方面的坚实基础，重症监护流行病学专家基于项目的指导， 因果推理和调查研究，选定的职业发展活动，以及具体的里程碑， 确保成功过渡到独立。Admon博士的主要导师是Colin Cooke，MD，MS，MSc。 他的共同导师是Andrew Ryan博士、Sarah Krein博士、RN和西奥多J. Iwashyna博士。 可行性：完成本建议书中的研究和培训将产生数据，为战略提供信息， 减轻碎片化，同时为Admon博士提供观察因果推理的高级技能， 调查方法在随后的工作中，这些专业知识将使他能够最大限度地利用观测数据 生成及时和准确的证据，以解决重症监护服务中的其他研究挑战。

PROJECT SUMMARY/ABSTRACT Candidate’s Long-Term Career Goal: To become an independent investigator who uses advanced observational research methods to improve the organization and delivery of critical care. Clinical Problem to be Addressed: Acute respiratory failure leads to 2,000,000 hospitalizations and 400,000 deaths in the US each year. Outcomes vary widely across hospitals, suggesting that improvements to how care is organized and delivered may improve survival. Yet, global changes affecting inpatient care teams have encouraged fragmentation—discontinuous care spread across multiple physicians. Little is known about how fragmented care affects adults with respiratory failure and what hospitals can do to protect patients from harm. Specific Aims: Using advanced methods for causal inference applied to novel data sources, Dr. Admon will 1) compare the causal effects of fragmented care on in-hospital and post-hospital respiratory failure outcomes; 2) determine whether specific complications occur more often in fragmented care and predict poorer outcomes; and 3) test whether specific features of inpatient care are protective against harm when care is fragmented. Candidate’s Background: Dr. Andrew Admon is a Lecturer and Research Fellow in Pulmonary and Critical Care Medicine at the University of Michigan. He has advanced training in public health and health care research. He has 25 total publications, including 17 original research manuscripts, with 7 original research manuscripts as first author. Dr. Admon’s work is supported by an NHLBI NRSA F32 award. Career Development Plan: To meet his long-term career goal, Dr. Admon seeks deep, focused training in causal inference and survey methodology. Accordingly, his 5-year plan includes curated courses that build on his strong foundation in quantitative research, project-based mentoring by experts in critical care epidemiology, causal inference, and survey research, selected career development activities, and specific milestones to ensure a successful transition to independence. Dr. Admon’s primary mentor is Colin Cooke, MD, MS, MSc. His co-mentors are Andrew Ryan, PhD, Sarah Krein, PhD, RN, and Theodore J. Iwashyna, MD, PhD. Deliverables: Completing the research and training in this proposal will generate data informing strategies to mitigate fragmentation while equipping Dr. Admon with advanced skills in observational causal inference and survey methods. In subsequent work, this expertise will prepare him to maximally leverage observational data to generate timely and accurate evidence addressing other research challenges in critical care delivery.