Describing, Contrasting, and Visualizing End-of-Life Care in the 21st Century

描述、对比和形象化 21 世纪的临终关怀

• 批准号: 8329472
• 负责人: GAIL M KEENAN
• 金额: $ 50.24万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-09 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8329472
• 关键词: Acute; Admission activity; Adverse event; Anxiety; Benchmarking; Cardiopulmonary; Care given by nurses; Caring; Cessation of life; Code; Computers; Data; Data Set; Databases; Diagnosis; Discipline of Nursing; Effectiveness; Electronic Health Record; Electronics; Evidence based practice; Family; Feedback; Focus Groups; Future; Goals; Hospital Units; Hospitalization; Hospitals; Hour; Imagery; Informatics; Intervention; Knowledge; Length of Stay; Life; Measurement; Medicare; Methods; Nurses; Nursing Diagnosis; Outcome; Pain; Pain management; Patients; Pattern; Persons; Practice based research; Process; Provider; Recording of previous events; Records; Risk; Sampling; Specific qualifier value; System; Terminology; Testing; Time; Translating; Videotape; Visual; base; care episode; clinical Diagnosis; clinically significant; data mining; demographics; end of life; fall risk; hospice environment; innovation; iterative design; meetings; nutrition; point of care; prospective; simulation; tool; usability

DESCRIPTION (provided by applicant): Our long-term goal is to reveal benchmarks and best practices for end-of-life (EOL) nursing care that support patients' dignity and comfort. Millions of dollars are spent each year on treatments of questionable value to hospitalized patients who are near death. The maturation of the electronic health records (EHRs) and standardized terminologies now make it possible to capture data and use it to determine the benchmarks and best practices of effective care or risks for adverse events. In our preliminary study of an extensive HANDS database of actual nursing care practices with 39,322 care episodes, we identified 1,394 EOL patients and we examined their "pain care" to demonstrate the feasibility of our methods and adequacy of power to determine effective pain benchmarks. This study yielded 4 statistically significant and clinically important benchmarks: (1) 51% of EOL patients failed to meet expected pain outcomes at discharge to hospice or death; (2) pain control achieved in the first 24 hours of care was predictive of pain control for the entire stay; (3) EOL patients with both cardiopulmonary and pain diagnoses had significantly poorer pain outcomes than those who do not; and (4) certain interventions were more likely to achieve pain control. We translated these pain benchmarks into an EHR user interface that is now ready for usability testing by a prospective sample. Building on these important findings, we propose to identify benchmarks and best practices for 5 additional care problems and 5 combinations of problems that are common to hospitalized EOL patients. From the validated dataset of care plan histories for 1,394 EOL patients from 8 different acute care units in 4 Midwestern hospitals, we will characterize EOL care using the following attributes: 1) patient and provider demographics; and 2) the nursing diagnoses, interventions, and outcomes as they evolved during each patient's care episode. Once we determine the benchmarks, then we will build a benchmarking system that presents the findings visually on EHR computer screens that help nurses to see and use the benchmarks as they plan and document care in the EHR. Our specific aims are to: Aim1. Determine patterns among all attributes recorded in HANDS for meaningful associations among the attributes that reveal benchmarks and best practices. Aim 2. In a diverse sample of 75 nurses, determine the usability (accessibility, visual appeal, content utility to guide intended use at the point of care) of new visualization screens that display the benchmarks for outcome pattern ratings (at the level of the person, unit, hospital, and across the 4 hospitals) and best practices. Study findings will inform future prospective practice-based research to verify the effectiveness of the benchmarking system to produce desired outcomes for hospitalized EOL patients. Such findings are urgently needed to enable best practice nursing care that supports hospitalized EOL patients' dignity and comfort as they die.

描述（由申请人提供）：我们的长期目标是揭示临终（EOL）护理的基准和最佳实践，以支持患者的尊严和舒适。每年都有数百万美元被花费在对濒临死亡的住院病人价值可疑的治疗上。电子健康记录（EHRs）的成熟和标准化术语现在使得捕获数据并使用它来确定有效护理或不良事件风险的基准和最佳实践成为可能。在我们对HANDS数据库中39,322次护理事件的实际护理实践进行的初步研究中，我们确定了1,394名EOL患者，并检查了他们的“疼痛护理”，以证明我们的方法的可行性和确定有效疼痛基准的充足性。本研究得出了4个具有统计学意义和临床重要性的基准：(1)51%的EOL患者在临终前或出院时未能达到预期的疼痛结局；(2)治疗前24小时的疼痛控制可以预测整个住院期间的疼痛控制；(3)同时进行心肺和疼痛诊断的EOL患者疼痛预后明显差于未进行心肺和疼痛诊断的EOL患者；(4)某些干预措施更有可能实现疼痛控制。我们将这些疼痛基准转换为EHR用户界面，该界面现在已经为潜在样本的可用性测试做好了准备。在这些重要发现的基础上，我们建议确定住院EOL患者常见的5个额外护理问题和5个问题组合的基准和最佳实践。从中西部4家医院的8个不同急症护理单位的1,394名EOL患者的护理计划历史验证数据集中，我们将使用以下属性来描述EOL护理：1)患者和提供者的人口统计学特征；2)护理诊断，干预措施和结果，因为他们在每个病人的护理过程中演变。一旦我们确定了基准，我们将建立一个基准系统，在电子病历的电脑屏幕上可视化地展示结果，帮助护士在电子病历中计划和记录护理时看到和使用基准。我们的具体目标是：确定HANDS中记录的所有属性之间的模式，以便在揭示基准和最佳实践的属性之间建立有意义的关联。目标2。在75名护士的不同样本中，确定新的可视化屏幕的可用性（可访问性、视觉吸引力、指导护理点预期用途的内容实用性），这些屏幕显示结果模式评级的基准（在个人、单位、医院和4家医院的层面上）和最佳实践。研究结果将为未来基于实践的前瞻性研究提供信息，以验证基准系统对住院EOL患者产生预期结果的有效性。这些发现是迫切需要的，以实现最佳实践护理，支持住院EOL患者的尊严和舒适，因为他们的死亡。