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
• 负责人: Meeta Prasad Kerlin
• 金额: $ 36.1万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 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: https://reporter.nih.gov/project-details/10636851
• 关键词: Accounting; Acute; Adherence; American; Care given by nurses; Caring; Characteristics; Clinical; Collaborations; Critical Illness; Discipline of Nursing; Dose; Economic Models; Economics; Effectiveness; Future; Health system; Hospital Mortality; Hospitals; Individual; Institution; Intensive Care Units; Interdisciplinary Study; International; Intervention; Interview; K-Series Research Career Programs; Knowledge; Length of Stay; Measurement; Measures; Mechanical ventilation; Mentors; Methodology; Methods; Modeling; Morbidity - disease rate; Nurses; Outcome; Patient Admission; Patient Care; Patient-Focused Outcomes; Patients; Pennsylvania; Performance; Physician' s Role; Physicians; Play; Policies; Population; Process; Recommendation; Research; Resources; Retrospective cohort study; Risk Adjustment; Role; Sampling; Science; Scientist; Sedation procedure; Societies; Standardization; Structure; Techniques; Testing; Time; United States Department of Veterans Affairs; United States National Institutes of Health; Universities; Work; acute care; brain dysfunction; cohort; cost; economic outcome; evidence base; high risk; high risk population; hospital care; improved; improved outcome; individual patient; innovation; member; mortality; nurse performance; patient population; programs; provider factors; respiratory; sedative; statistics; team-based care; tool

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.

项目概要 每年有多达 100 万美国人接受机械通气 (MV)，且患病率很高 发病率和死亡率。尽管有改善治疗结果的高质量证据， 对最佳实践的遵守情况和患者的治疗结果仍然存在差异。 MV 患者几乎得到普遍护理 在重症监护病房 (ICU)，跨专业团队护理 – 涉及医生、呼吸系统 治疗师、护士等——是常态。基于团队的护理的好处的证据推动了 国际社会支持这一模式的建议；然而，团队的最佳实践 合作仍未知。我们已经证明，医生会导致 MV 结果的变异性 其他研究表明，特定的护理因素与患者的病情相关。 结果。然而，之前的研究并没有在评估个人时考虑到整个团队。 成员。更好地了解 ICU 团队不同成员的角色和贡献 将为可以改善这一高危人群患者预后的实践和干预措施提供信息。这 因此，该提案的主要目标是更好地了解医生的相对贡献， 护士和呼吸治疗师单独或以团队形式评估接受 MV 的患者的结果。我们将 使用“增值模型”（VAM），这是一种针对经验个人绩效而开发的经济方法 当多个人在一个流程中工作时进行测量。 VAM 已经过测量验证 急症护理护士的表现，并且特别适合这个问题，因为它解释了多重因素 影响个体患者结果的临床医生。我们将通过四个目标来实现我们的目标。第一的， 我们将应用 VAM 来模拟广大 MV 人群中临床医生和患者病情严重程度之间的关系 患者，以便估计每个专业组内的相对临床医生表现。其次，我们将 比较医生、护士和呼吸治疗师基于 VAM 的绩效贡献 广泛的患者和经济成果。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，解释为 多变量模型中的不同变量组。第三，我们稍后评估VAM的性能 退伍军人管理局紧急护理国家样本中收治的 MV 患者群体 医院以及未接受 MV 的患者，评估 VAM 方法的普遍性来估计 临床医生的表现。第四，我们将确定与更高绩效相关的临床医生和团队因素 使用混合方法。这项研究将进一步我们对相关临床医生的了解 使用创新建模技术对患者结果做出贡献，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 未来的工作是减少接受 MV 的高危人群的护理变异性。