Economic modeling to understand the relationship between clinicians and outcomes of mechanically ventilated patients
通过经济模型了解临床医生与机械通气患者预后之间的关系
基本信息
- 批准号:10413996
- 负责人:
- 金额:$ 36.67万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-06-01 至 2025-05-31
- 项目状态:未结题
- 来源:
- 关键词:AccountingAcuteAdherenceAmericanCare given by nursesCaringCharacteristicsClinicalCollaborationsCritical CareCritical IllnessDiscipline of NursingDoseEconomic ModelsEconomicsEffectivenessFutureHealth systemHospital MortalityHospitalsIndividualIntensive Care UnitsInterdisciplinary StudyInternationalInterventionInterviewK-Series Research Career ProgramsKnowledgeLeadLength of StayMeasurementMeasuresMechanical ventilationMentorsMethodologyMethodsModelingMorbidity - disease rateNursesOutcomePatient CarePatient-Focused OutcomesPatientsPennsylvaniaPerformancePhysician&aposs RolePhysiciansPlayPoliciesPopulationProcessRecommendationResearchResourcesRetrospective cohort studyRiskRoleSamplingScienceScientistSedation procedureSocietiesStandardizationStructureTechniquesTestingTimeUnited States Department of Veterans AffairsUnited States National Institutes of HealthUniversitiesWorkacute carebasebrain dysfunctioncare outcomescohortcosteconomic outcomeevidence basehigh riskhigh risk populationimprovedimproved outcomeindividual patientinnovationmembermortalitynurse performancepatient populationprogramsprovider factorsrespiratorysedativetool
项目摘要
PROJECT SUMMARY
Up to one million Americans undergo mechanical ventilation (MV) each year and are subject to high rates of
morbidity and mortality. Despite the availability of high-quality evidence for therapies that improve outcomes,
adherence to best practices and patient outcomes remain variable. MV patients are nearly universally cared for
in intensive care units (ICUs), where interprofessional team-based care – involving physicians, respiratory
therapists, and nurses, among others – is the norm. Evidence for the benefits of team-based care has driven
recommendations from international societies to support this model; however, best practices for team
collaboration remain unknown. We have shown that physicians contribute to variability in outcomes of MV
patients, and other studies have demonstrated that specific nursing factors are associated with patient
outcomes. However, previous studies have not accounted for the entire team in assessment of individual
members. An improved understanding of the roles and contributions of different members of an ICU team
would inform practices and interventions that could improve patient outcomes in this high risk population. The
primary objective of this proposal, therefore, is to better understand the relative contributions of physicians,
nurses, and respiratory therapists individually and as teams to outcomes of patients who undergo MV. We will
use “value-added modeling” (VAM), an economic approach developed for empirical individual performance
measurement when multiple individuals work in a single process. VAM has been validated for measuring
performance of acute care nurses and is uniquely suited to this question, in that it accounts for the multiple
clinicians that influence outcomes of individual patients. We will achieve our objective through four aims. First,
we will apply VAM to model the relationship between clinicians and patient acuity in a broad population of MV
patients, in order to estimate relative clinician performance within each professional group. Second, we will
compare the contributions of physician, nurse, and respiratory therapist performance based on VAM across a
broad range of patient and economic outcomes. We will quantify the contributions of clinician performance
relative to patient factors using the omega statistic, a method for estimating the relative variance explained by
different variable groups in a multivariable model. Third, we will evaluate the performance of VAM in a second
patient population of MV patients admitted to a national sample of Veterans Administration acute care
hospitals, and in patients who do not undergo MV, to evaluate the generalizability of VAM methods to estimate
clinician performance. Fourth, we will identify clinician and team factors associated with higher performance
using a mixed-methods approach. This study will further our understanding of the relative clinician
contributions to patient outcomes using innovative modeling techniques, will contribute to the evidence base
for team-based care of critically ill patients, will advance the field of team effectiveness, and will directly lead to
future work to reduce care variability among the high-risk population of patients who undergo MV.
项目摘要
每年有多达一百万美国人接受机械通气(MV),并且受到高比率的呼吸道感染。
发病率和死亡率。尽管有高质量的证据证明治疗可以改善预后,
遵守最佳做法和病人的结果仍然是可变的。MV患者几乎得到普遍护理
在重症监护室(ICU),其中跨专业团队护理-包括医生,呼吸系统
治疗师,护士,还有其他人-这是常态。基于团队的护理的好处的证据已经驱动了
国际社会的建议来支持这种模式;然而,团队的最佳实践
合作仍然未知。我们已经表明,医生有助于变异的结果,MV
患者,其他研究表明,特定的护理因素与患者
结果。然而,以前的研究没有考虑到整个团队在评估个人
成员更好地理解ICU团队不同成员的角色和贡献
将告知实践和干预措施,可以改善这一高风险人群的患者结局。的
因此,本提案的主要目的是更好地理解医生的相对贡献,
护士和呼吸治疗师单独或作为团队对接受MV的患者的结果进行评估。我们将
使用“增值建模”(VAM),这是一种针对实证个人绩效开发的经济方法
当多个人在一个过程中工作时进行测量。VAM已经过验证,可用于测量
急性护理护士的表现,是唯一适合这个问题,因为它占了多个
影响个体患者结局的临床医生。我们将通过四个目标来实现我们的目标。第一、
我们将应用VAM在广泛的MV人群中模拟临床医生和患者急性之间的关系
患者,以便估计每个专业组内的相对临床医生表现。二是
比较医生,护士和呼吸治疗师在VAM的基础上表现的贡献,
广泛的患者和经济结果。我们将量化临床医生绩效的贡献
相对于使用omega统计量的患者因素,一种估计相对方差的方法,
多变量模型中的不同变量组。第三,我们将评估VAM的性能,
入选退伍军人管理局急性护理国家样本的MV患者人群
医院,并在不接受MV的患者中,评估VAM方法的普遍性,以估计
临床医生表现。第四,我们将确定与更高性能相关的临床医生和团队因素
使用混合方法。这项研究将进一步加深我们对相关临床医生的了解
使用创新的建模技术对患者结局的贡献,将有助于证据基础
对于危重病人的团队护理,将提高团队效率,并将直接导致
未来的工作,以减少护理变异的高风险人群的患者谁接受MV。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Meeta Prasad Kerlin其他文献
Towards evidence-based staffing: the promise and pitfalls of patient-to-intensivist ratios
- DOI:
10.1007/s00134-021-06614-9 - 发表时间:
2022-01-13 - 期刊:
- 影响因子:21.200
- 作者:
Meeta Prasad Kerlin;Pedro Caruso - 通讯作者:
Pedro Caruso
Racial differences in odds of asthma exacerbations among emAspergillus fumigatus/em–sensitized adults with asthma
在烟曲霉致敏的成年哮喘患者中哮喘加重几率的种族差异
- DOI:
10.1016/j.anai.2024.08.959 - 发表时间:
2025-02-01 - 期刊:
- 影响因子:4.700
- 作者:
Patrick K. Gleeson;Knashawn H. Morales;Meeta Prasad Kerlin;Olajumoke O. Fadugba;Andrea J. Apter;Jason D. Christie;Blanca E. Himes - 通讯作者:
Blanca E. Himes
Ward Capacity Strain: A Novel Predictor of 30-Day Hospital Readmissions
- DOI:
10.1007/s11606-018-4564-x - 发表时间:
2018-07-18 - 期刊:
- 影响因子:4.200
- 作者:
Rachel Kohn;Michael O. Harhay;Brian Bayes;Mark E. Mikkelsen;Sarah J. Ratcliffe;Scott D. Halpern;Meeta Prasad Kerlin - 通讯作者:
Meeta Prasad Kerlin
Nighttime physician staffing improves patient outcomes: no
- DOI:
10.1007/s00134-016-4367-7 - 发表时间:
2016-06-27 - 期刊:
- 影响因子:21.200
- 作者:
Meeta Prasad Kerlin;Scott D. Halpern - 通讯作者:
Scott D. Halpern
Procedure-specific consent is the norm in United States intensive care units
- DOI:
10.1007/s00134-016-4433-1 - 发表时间:
2016-07-14 - 期刊:
- 影响因子:21.200
- 作者:
Elliott Mark Weiss;Rachel Kohn;Vanessa Madden;Scott Halpern;Steven Joffe;Meeta Prasad Kerlin - 通讯作者:
Meeta Prasad Kerlin
Meeta Prasad Kerlin的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Meeta Prasad Kerlin', 18)}}的其他基金
Economic modeling to understand the relationship between clinicians and outcomes of mechanically ventilated patients
通过经济模型了解临床医生与机械通气患者预后之间的关系
- 批准号:
10709312 - 财政年份:2023
- 资助金额:
$ 36.67万 - 项目类别:
Economic modeling to understand the relationship between clinicians and outcomes of mechanically ventilated patients
通过经济模型了解临床医生与机械通气患者预后之间的关系
- 批准号:
10851229 - 财政年份:2020
- 资助金额:
$ 36.67万 - 项目类别:
Economic modeling to understand the relationship between clinicians and outcomes of mechanically ventilated patients
通过经济模型了解临床医生与机械通气患者预后之间的关系
- 批准号:
10636851 - 财政年份:2020
- 资助金额:
$ 36.67万 - 项目类别:
Implementation of behavioral economic approaches to improve evidence uptake for mechanically ventilated patients
实施行为经济学方法以提高机械通气患者的证据吸收
- 批准号:
10370335 - 财政年份:2019
- 资助金额:
$ 36.67万 - 项目类别:
Implementation of behavioral economic approaches to improve evidence uptake for mechanically ventilated patients
实施行为经济学方法以提高机械通气患者的证据吸收
- 批准号:
10614507 - 财政年份:2019
- 资助金额:
$ 36.67万 - 项目类别:
Implementation of behavioral economic approaches to improve evidence uptake for mechanically ventilated patients
实施行为经济学方法以提高机械通气患者的证据吸收
- 批准号:
9888214 - 财政年份:2019
- 资助金额:
$ 36.67万 - 项目类别:
The role of physician experience in outcomes of patients with acute respiratory f
医生经验对急性呼吸道疾病患者预后的影响
- 批准号:
8581384 - 财政年份:2013
- 资助金额:
$ 36.67万 - 项目类别:
The role of physician experience in outcomes of patients with acute respiratory f
医生经验对急性呼吸道疾病患者预后的影响
- 批准号:
9301632 - 财政年份:2013
- 资助金额:
$ 36.67万 - 项目类别:
The role of physician experience in outcomes of patients with acute respiratory f
医生经验对急性呼吸道疾病患者预后的影响
- 批准号:
8882542 - 财政年份:2013
- 资助金额:
$ 36.67万 - 项目类别:
The role of physician experience in outcomes of patients with acute respiratory f
医生经验对急性呼吸道疾病患者预后的影响
- 批准号:
8705000 - 财政年份:2013
- 资助金额:
$ 36.67万 - 项目类别:
相似海外基金
Transcriptional assessment of haematopoietic differentiation to risk-stratify acute lymphoblastic leukaemia
造血分化的转录评估对急性淋巴细胞白血病的风险分层
- 批准号:
MR/Y009568/1 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Fellowship
Combining two unique AI platforms for the discovery of novel genetic therapeutic targets & preclinical validation of synthetic biomolecules to treat Acute myeloid leukaemia (AML).
结合两个独特的人工智能平台来发现新的基因治疗靶点
- 批准号:
10090332 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Collaborative R&D
Acute senescence: a novel host defence counteracting typhoidal Salmonella
急性衰老:对抗伤寒沙门氏菌的新型宿主防御
- 批准号:
MR/X02329X/1 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Fellowship
Cellular Neuroinflammation in Acute Brain Injury
急性脑损伤中的细胞神经炎症
- 批准号:
MR/X021882/1 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Research Grant
STTR Phase I: Non-invasive focused ultrasound treatment to modulate the immune system for acute and chronic kidney rejection
STTR 第一期:非侵入性聚焦超声治疗调节免疫系统以治疗急性和慢性肾排斥
- 批准号:
2312694 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Standard Grant
Combining Mechanistic Modelling with Machine Learning for Diagnosis of Acute Respiratory Distress Syndrome
机械建模与机器学习相结合诊断急性呼吸窘迫综合征
- 批准号:
EP/Y003527/1 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Research Grant
FITEAML: Functional Interrogation of Transposable Elements in Acute Myeloid Leukaemia
FITEAML:急性髓系白血病转座元件的功能研究
- 批准号:
EP/Y030338/1 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Research Grant
KAT2A PROTACs targetting the differentiation of blasts and leukemic stem cells for the treatment of Acute Myeloid Leukaemia
KAT2A PROTAC 靶向原始细胞和白血病干细胞的分化,用于治疗急性髓系白血病
- 批准号:
MR/X029557/1 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Research Grant
ロボット支援肝切除術は真に低侵襲なのか?acute phaseに着目して
机器人辅助肝切除术真的是微创吗?
- 批准号:
24K19395 - 财政年份:2024
- 资助金额:
$ 36.67万 - 项目类别:
Grant-in-Aid for Early-Career Scientists
Acute human gingivitis systems biology
人类急性牙龈炎系统生物学
- 批准号:
484000 - 财政年份:2023
- 资助金额:
$ 36.67万 - 项目类别:
Operating Grants