Understanding Inappropriate Treatment in Critically Ill Older Patients

了解老年危重患者的不当治疗

• 批准号: 9222687
• 负责人: THANH H NEVILLE
• 金额: $ 16.85万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9222687
• 关键词: Age; Aging; Behavior; Biometry; Caring; Cessation of life; Clinical; Clinical Research; Communication; Comorbidity; Complement; Complex; Critical Care; Critical Illness; Data; Decision Making; Distress; Elderly; Ethics; Faculty; Family; Futile Treatments; Future; General Population; Geriatrics; Goals; Gray unit of radiation dose; Health Services; Healthcare; Institution; Intensive Care Units; Intervention; Judgment; Lead; Life; Lung; Medical; Medical Records; Medicine; Mentors; Methods; Modeling; Palliative Care; Patient-Focused Outcomes; Patients; Physicians; Process; Public Health; Qualitative Methods; Research; Research Personnel; Resources; Risk; Statistical Models; System; Technology; Work; base; burden of illness; career; experience; implementation science; improved; member; mortality; multi-component intervention; multidisciplinary; older patient; outcome forecast; patient subsets; preference; prospective; public health relevance; research and development; successful intervention; therapy development; tool

 DESCRIPTION (provided by applicant): Dr. Thanh Neville is a junior faculty member in the Division of Pulmonary and Critical Care at UCLA who has the long-term goal of using research to improve the quality and appropriateness of care in the intensive care unit (ICU). Her career objective is to become an independent investigator and an academic leader in aging and critical care research. She is currently mentored by Dr. Neil Wenger, who is a well-known health services researcher and the Director of the UCLA Ethics Center. She also has a multi-disciplinary team of well-qualified co-mentors and advisors who will each provide direction in qualitative analysis, statistical modeling, aging research, and intervention development and implementation. Formal courses at UCLA in qualitative methods, aging, implementation science, and biostatistics will complement the guidance she receives from her mentors. She is strongly supported by her division and will be performing her research at UCLA, an institution renowned for its academic, clinical, and research excellence. In this proposal, Dr. Neville seeks to characterize the factors related to older patients receiving inappropriate treatment in the ICU and how physician behavior and system-wide practices might be changed to transition such treatment toward appropriate palliative care. Older patients are the largest growing subset of patients requiring care in the ICU and are vulnerable to the harmful effects of the mismatch of treatment to prognosis. Inappropriate treatment, defined here as a treatment that should not be provided because it does not offer the patient benefit, can prolong suffering, cause family distress, and transform death into an undignified process. This project builds on Dr. Neville's work in defining and quantitating inappropriate treatment in the ICU. It explores and analyzes a previously completed medical record abstraction that she has collected on patients who received inappropriate treatment, patients who received probably inappropriate treatment, and patients who did not receive inappropriate treatment in the ICU. The goal of the proposed project is to 1) use qualitative and quantitative methods to explore the patient, physician, communication, and structural factors related to provision of inappropriate ICU treatment for older critically ill patients, 2) develop and validate a prospective tool to identify patients at rsk of inappropriate treatment at entry into the ICU, and 3) develop and pilot an intervention to decrease inappropriate treatment in the ICU. This application will be a step toward developing interventions that successfully reorient critical care when the prognosis is poor.

 描述（由申请人提供）：Thanh Neville博士是加州大学洛杉矶分校肺部和重症监护科的初级教员，他的长期目标是利用研究来提高重症监护室（ICU）的护理质量和适当性。她的职业目标是成为一名独立的调查员和老龄化和重症监护研究的学术领导者。她目前由Neil Wenger博士指导，Neil Wenger博士是着名的卫生服务研究员和加州大学洛杉矶分校伦理中心主任。她还拥有一支由合格的共同导师和顾问组成的多学科团队，他们将分别在定性分析，统计建模，老龄化研究以及干预开发和实施方面提供指导。在加州大学洛杉矶分校的定性方法，老化，实施科学和生物统计学的正式课程将补充她从导师那里得到的指导。她得到了她所在部门的大力支持，并将在加州大学洛杉矶分校进行研究，该机构以其学术，临床和研究卓越而闻名。在这项提案中，内维尔博士试图描述与老年患者在ICU接受不适当治疗相关的因素，以及如何改变医生的行为和全系统的做法，以将这种治疗过渡到适当的姑息治疗。老年患者是需要ICU护理的患者中最大的增长子集，并且容易受到治疗与预后不匹配的有害影响。不适当的治疗，在这里被定义为不应该提供的治疗，因为它不提供病人的利益，可以延长痛苦，造成家庭痛苦，并把死亡变成一个不体面的过程。该项目建立在内维尔博士在定义和量化ICU中不适当治疗的工作基础上。它探讨和分析了以前完成的医疗记录摘要，她已经收集了病人谁收到不适当的治疗，病人谁收到可能不适当的治疗，和病人谁没有收到不适当的治疗在ICU。该项目的目标是：1）使用定性和定量方法来探索与为老年重症患者提供不适当ICU治疗相关的患者、医生、沟通和结构因素，2）开发并验证一种前瞻性工具，以识别进入ICU时存在不适当治疗的患者，3）制定并试行干预措施，减少ICU中的不当治疗。这一应用将是朝着开发干预措施迈出的一步，当预后不良时，成功地重新调整重症监护。