The role of physician experience in outcomes of patients with acute respiratory f

描述(由申请人提供)：需要机械通气的急性呼吸衰竭患者的发病率和死亡率很高。尽管最近的一些进展改善了对这类患者的管理，但这些治疗方法还没有完全被采用，患者的结果在不同的医院仍然不同。一个可能与改进将证据转化为实践相关的因素是医生提供者的经验。以前的研究间接提供了这种关系的证据；例如，较高的年医院容量与较低的死亡率相关。然而，几乎没有直接的证据，医生的经验还没有被定义，组织解决方案修改关系的能力也是未知的。更好地了解这种复杂的关系可以揭示干预措施的新目标，以改善机械通气患者的循证实践，并最终提高他们的结果。因此，这项建议的总体目标是了解医生经验与机械通气患者预后之间的关系。具体地说，我们将确定(1)医生经验(定义为完成培训后的年限)与患者结果之间是否存在关联；(2)医生经验和医院容量对患者结果的相对贡献；以及(3)医生经验的影响是否因组织因素的存在而改变。对于这个项目，我们将创建一个创新的数据库，将宾夕法尼亚州住院患者的多个公开可用管理和临床数据集与从全州医院调查中获得的数据联系起来，并将使用最先进的统计建模技术来促进我们对医生在患者结果中的作用的理解。这一数据库和职业发展奖将为候选人未来的工作奠定基础，成为一名独立的临床研究人员，专注于开发和实施组织干预措施，以改善急性呼吸衰竭患者的护理。米塔·普拉萨德·科林博士拥有肺部和重症护理医学的临床背景，并拥有宾夕法尼亚大学临床流行病学理学硕士学位。她通过成功完成几个关于危重护理结果和教育主题的研究项目，展示了她对临床研究的兴趣和天赋。她曾在JAMA和危重病护理医学等高影响力期刊上发表过多篇论文。在这份提案中，她制定了一项职业发展计划，其中包括教学学习、有组织的专业发展、密集的指导和领导上述项目的直接研究经验的补充方法。她得到了她所在部门的全力支持，得到了已经是重症监护结果研究领导者的杰出导师的全力支持，并获得了宾夕法尼亚大学的大量资源。总而言之，这些都将确保她凭借自己的能力成功地发展成为一名领导者。

DESCRIPTION (provided by applicant): Patients with acute respiratory failure requiring mechanical ventilation are at high risk for morbidity and mortality. Although several recent advances have improved management of such patients, these therapies have been incompletely adopted and patient outcomes continue to vary across hospitals. One factor that may be associated with improved translation of evidence into practice is the experience of the physician provider. Previous studies indirectly provide evidence for this relationship; for example, higher annual hospital volume is associated with reduced mortality. However, there is little direct evidence, physician "experience" has not been defined, and the capacity of organizational solutions to modify the relationship is unknown. A better understanding of this complex relationship could reveal novel targets for interventions to improve uptake of evidence-based practices of mechanically ventilated patients and ultimately their outcomes. Therefore the overall goal of this proposal is to understand the relationship between physician experience and outcomes for mechanically ventilated patients. Specifically, we will determine (1) if there is an association of physician experience, defined as years since completing of training, with patient outcomes; (2) the relative contributions of physician experience and hospital volume to patient outcomes; and (3) if effects of physician experience are modified by the presence of organizational factors. For this project we will create an innovative database linking multiple publicly available administrative and clinical datasets of patients hospitalized in the state of Pennsylvania with data obtained from a state-wide hospital survey and will use state-of-the-art statistical modeling techniques to advance our understanding of the role of the physician in patient outcomes. This database and career development award will be a foundation for the candidate's future work as an independent clinical researcher with a focus on developing and implementing organizational interventions to improve care of patients with acute respiratory failure. Dr. Meeta Prasad Kerlin has a clinical background in pulmonary and critical care medicine and a Master of Science in Clinical Epidemiology from the University of Pennsylvania. She has demonstrated her interest and aptitude for clinical research through the successful completion of several research projects in the topics of critical care outcomes and education. She has had multiple publications in high-impact journals such as JAMA and Critical Care Medicine. In this proposal, she has developed a career development plan that includes a complementary approach of didactic learning, structured professional development, intensive mentorship, and direct research experience leading the project described above. She has the full support of her department, outstanding mentors who are already the leaders in critical care outcomes research, and access to the vast resources of the University of Pennsylvania. Together, these will ensure her successful development into a leader in her own right.