Improving patient- and family-centered outcomes and value of care for patients with chronic illness who develop acute respiratory failure

改善发生急性呼吸衰竭的慢性病患者的以患者和家庭为中心的结果和护理价值

• 批准号: 9817160
• 负责人: Nita Khandelwal
• 金额: $ 19.02万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9817160
• 关键词: Acute respiratory failure; Address; Adult; Anesthesiology; Biomedical Research; Biometry; Caring; Child; Chronic; Chronic Disease; Clinical Research; Clinical Trials; Clinical and Translational Science Awards; Complex; Critical Illness; Data; Development; Development Plans; Electronic Health Record; Environment; Evaluation; Family; Family member; Feedback; Financial Hardship; Funding; Future; Goals; Grant; Health; Healthcare; Hospitals; Institutes; Institution; Intensive Care; Intensive Care Units; Intervention; Interview; Knowledge; Lead; Life; Link; Longitudinal cohort study; Measures; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Outcome; Pain; Palliative Care; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Physically Handicapped; Physicians; Population; Public Health Schools; Qualitative Methods; Records; Reporting; Research; Research Personnel; Research Proposals; Research Training; Resources; Retrospective cohort; Risk; Role; Scientist; Socioeconomic Status; Statistical Methods; Structure; Supportive care; Time; Training; Universities; Vulnerable Populations; Washington; Work; care costs; career; career development; cognitive disability; cost; design; experience; frailty; functional disability; functional status; high risk; improved; improved outcome; innovation; interest; novel; palliative; patient oriented research; programs; psychological distress; psychological symptom; skill acquisition; skills; success; therapy design; translational health science

PROJECT SUMMARY/ABSTRACT Candidate: This K23 award will provide an opportunity for Dr. Khandelwal to achieve her long-term goal of being an independently funded physician scientist with a focus on improving patient- and family-centered outcomes for patients with acute respiratory failure (ARF) and their family members. Through this proposal, Dr. Khandelwal will achieve her immediate goals of acquiring: 1) expertise in the evaluation of patient-and family-reported outcomes, use of qualitative methods to inform the development and assessment of interventions, and training in advanced multi-level statistical methods and clinical trials; and 2) pilot data and skills to successfully apply for R level grants that include clinical trials and longitudinal cohort studies. These objectives will be achieved through a career development plan that incorporates formal coursework, skilled mentoring, and protected time to gain research experience in an outstanding environment. Research: In this patient-oriented research proposal, Dr. Khandelwal will identify patients with ARF and chronic illness who are at greatest risk for poor outcomes (psychological distress, functional impairment, financial stress), and the types of supportive and palliative interventions that would be most helpful in improving these outcomes. To accomplish this, she will: 1) identify predictors of poor patient and family outcomes, including number and type of chronic conditions, measures of frailty, and prior healthcare use; 2) identify predictors of high hospital and ICU utilization and costs; and 3) explore patient, family, and clinician perspectives on the types, timing, and feasibility of supportive and palliative interventions that they believe would improve these outcomes. To date, attempts to improve patient or family outcomes have been disappointing and suggest the need for interventions targeted to specific populations and specific needs. Findings from these aims will result in innovative interventions for patients with ARF who are at greatest risk for poor outcomes and potentially burdensome, costly care. By efficiently targeting supportive and palliative care resources to those who need and may benefit most, this study has the potential to improve value-driven care to this vulnerable population. Environment: The University of Washington (UW) is an ideal setting for Dr. Khandelwal's research training. UW is an outstanding biomedical research institution with a strong commitment to promoting the academic careers of promising investigators. The UW Department of Anesthesiology & Pain Medicine is widely recognized for its support of early career physician scientists in development of the skills necessary to achieve academic success. In addition to the resources provided within her Department, Dr. Khandelwal will also have the full support of the Cambia Palliative Care Center of Excellence at UW (directed by her primary mentor) and will have access to clinical research and biostatistical support through the UW School of Public Health and the Institute of Translational Health Sciences (the Clinical and Translational Science Award program at UW).

项目概要/摘要 候选人：K23 奖项将为 Khandelwal 博士提供实现其长期目标的机会 是一名独立资助的医师科学家，专注于改善以患者和家庭为中心的 急性呼吸衰竭（ARF）患者及其家人的结局。通过这个提案， Khandelwal 博士将实现她的近期目标：1) 评估患者和患者的专业知识 家庭报告的结果，使用定性方法为发展和评估提供信息 先进的多层次统计方法和临床试验的干预措施和培训； 2) 试点数据和 成功申请 R 级资助的技能，包括临床试验和纵向队列研究。这些 目标将通过职业发展计划来实现，其中包括正式的课程作业、熟练的 指导和保护时间，以便在出色的环境中获得研究经验。 研究：在这项以患者为导向的研究计划中，Khandelwal 博士将识别 ARF 患者并 慢性病患者最有可能出现不良后果（心理困扰、功能障碍、 财务压力），以及最有帮助的支持性和姑息性干预措施的类型 改善这些结果。为了实现这一目标，她将：1）确定贫困患者及其家庭的预测因素 结果，包括慢性病的数量和类型、虚弱程度以及既往医疗保健使用情况； 2） 确定医院和 ICU 高利用率和成本的预测因素； 3) 探索患者、家属和临床医生 他们认为支持性和姑息性干预措施的类型、时机和可行性的观点 将改善这些结果。迄今为止，改善患者或家庭结局的尝试已经 令人失望，并建议需要针对特定​​人群和特定需求采取干预措施。 这些目标的发现将为 ARF 患者带来创新的干预措施，这些患者面临最大的风险 不良的结果和潜在的繁重且昂贵的护理。通过有效地针对支持性和姑息治疗 资源提供给那些需要并可能受益最大的人，这项研究有可能改善价值驱动的护理 这个弱势群体。 环境：华盛顿大学 (UW) 是 Khandelwal 博士进行研究培训的理想环境。 华盛顿大学是一所杰出的生物医学研究机构，致力于促进学术发展 有前途的研究人员的职业生涯。华盛顿大学麻醉学和疼痛医学系广泛 因其支持早期职业医师科学家发展实现目标所需的技能而受到认可 学术上的成功。除了她所在部门提供的资源外，Khandelwal 博士还将拥有 华盛顿大学坎比亚姑息治疗卓越中心（由她的主要导师指导）的全力支持以及 将通过华盛顿大学公共卫生学院和美国华盛顿大学公共卫生学院获得临床研究和生物统计支持 转化健康科学研究所（华盛顿大学的临床和转化科学奖计划）。