Improving clinical outcomes after ICU transfer for acute respiratory failure

改善急性呼吸衰竭转入 ICU 后的临床结果

• 批准号: 10064002
• 负责人: Ann Long Jennerich
• 金额: $ 18.82万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-12-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064002
• 关键词: Acute; Acute respiratory failure; Admission activity; Affect; Anxiety; Area; Award; Biomedical Research; Biometry; Caring; Clinical; Clinical Research; Clinical and Translational Science Awards; Communication; Critical Care; Critical Illness; Data; Deterioration; Development; Development Plans; Elements; Emotional; Environment; Epidemiology; Family; Family member; Feedback; Fright; Future; Goals; Institutes; Institution; Intensive Care Units; Intervention; Interview; Knowledge; Learning; Link; Lung; Mediation; Medical center; Medicine; Mentors; Methods; Mood Disorders; Outcome; Outcomes Research; Palliative Care; Patient Care; Patient Transfer; Patient-Focused Outcomes; Patients; Physicians; Pilot Projects; Population; Process; Prospective cohort study; Public Health Schools; Qualitative Methods; Quality of life; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Role; Sampling; Structure; Symptoms; Techniques; Time; Training; Treatment Efficacy; Universities; Washington; Work; acute care; base; career; career development; cohort; depressive symptoms; design; educational atmosphere; end of life; experience; feasibility testing; high risk; implementation facilitation; implementation intervention; improved; improved outcome; innovation; loved ones; mortality; palliative; patient population; patient response; post-traumatic stress; preference; programs; psychologic; psychological distress; psychological outcomes; psychological symptom; randomized trial; respiratory; response; skill acquisition; skills; success; therapy design; tool; translational health science

PROJECT SUMMARY/ABSTRACT Candidate: Dr. Long’s long-term goal is to improve patient- and family-centered outcomes for patients with acute respiratory failure and their family members. This award will provide Dr. Long with essential research training to support her goal of becoming an independent investigator in the fields of palliative care and pulmonary and critical care medicine. Through this proposal Dr. Long will acquire new skills through four specific learning objectives designed to provide structured training in: 1) the role of mood disorders and the use of psychological outcomes in critical care research; 2) advanced epidemiologic and biostatistics techniques; 3) rigorous qualitative methods; and 4) the design and implementation of randomized trials. These objectives will be achieved through a career development plan that incorporates formal coursework, mentoring by experts in clinical outcomes research, and protected time to gain research experience in an exceptional learning environment. Research: Patients transferred from acute care to the intensive care unit (ICU) for acute respiratory failure represent a population at high risk for poor clinical outcomes. These patients and their family members are likely to benefit from high-quality palliative care tailored to their needs. Palliative care is care focused on patients with serious illness with the goal of improving quality of life for both the patient and family by providing high-quality communication, symptom control, and emotional and spiritual support. Interventions to improve palliative care for patients transferred to the ICU for acute respiratory failure will require a substantial improvement in our understanding of the experiences and needs of patients and their family members. To date, studies of transfers from acute care to the ICU have focused on predictors of ICU transfer and mortality after ICU admission. The research proposed in this application is innovative because it represents a substantive departure from these approaches. The primary objective of this K23 is to develop an understanding of the transfer process from a patient- and family-centered perspective in order to facilitate implementation of an intervention to improve palliative care for patients and their family members after patient transfer from acute care to the ICU for acute respiratory failure. To achieve this objective, Dr. Long will identify a cohort of patients transferred from acute care to the ICU for acute respiratory failure at two medical centers. With this cohort of patients and their family members, Dr. Long will: 1) conduct a prospective cohort study to identify elements of the transfer process associated with family member symptoms of depression, anxiety, and posttraumatic stress; 2) use qualitative interviews of patients, family members, and clinicians to define the palliative care needs of patients and family members; and 3) conduct a pilot randomized trial to test the feasibility and preliminary efficacy of an intervention to improve palliative care for patients and their family after patient transfer from acute care to the ICU. Environment: The University of Washington (UW) is an ideal setting for Dr. Long’s research training. UW is an outstanding biomedical research institution with a strong commitment to promoting the academic careers of promising investigators. The UW Division of Pulmonary and Critical Care Medicine is widely recognized for its Clinical Research Training Track and offers an intellectual environment that supports development of the skills necessary to achieve academic success. In addition to the resources provided within the Division, Dr. Long 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).

项目总结/摘要 候选人：Long博士的长期目标是改善以患者和家庭为中心的结果， 急性呼吸衰竭及其家属。该奖项将为朗博士提供必要的研究 培训，以支持她成为姑息治疗领域的独立调查员的目标， 肺和重症监护医学。通过这项提案，朗博士将通过四个方面获得新的技能。 具体的学习目标，旨在提供结构化的培训：1）情绪障碍的作用和使用 重症监护研究中的心理结果; 2）先进的流行病学和生物统计学技术; 3） 严格的定性方法; 4）随机试验的设计和实施。这些目标将 通过职业发展计划实现，该计划包括正式课程， 临床结果研究，并保护时间，以获得研究经验，在一个特殊的学习 环境 研究：因急性呼吸衰竭从急诊室转入重症监护室（ICU）的患者 代表临床结局不良的高风险人群。这些病人和他们的家人是 可能受益于针对其需求量身定制的高质量姑息治疗。姑息治疗是关注 严重疾病患者，目标是通过提供 高质量的沟通、症状控制以及情感和精神支持。干预措施来改善 对因急性呼吸衰竭转入ICU的患者进行姑息治疗需要大量的 提高我们对病人及其家属的经验和需要的了解。到 迄今为止，关于从急症护理转移到ICU的研究主要集中在ICU转移和死亡率的预测因素上 ICU入院后这项申请中提出的研究是创新的，因为它代表了一个 这些方法的实质性偏离。K23的主要目标是开发一种 从以患者和家庭为中心的角度了解转移过程，以促进 实施干预措施，改善患者及其家属姑息治疗 因急性呼吸衰竭从急诊室转到ICU。为了实现这一目标，朗博士将确定 两个医疗中心因急性呼吸衰竭从急诊室转到ICU的一组患者。 对于这组患者及其家属，Long博士将：1）进行前瞻性队列研究， 确定与家庭成员抑郁、焦虑症状相关的转移过程的要素， 创伤后应激; 2）使用患者，家庭成员和临床医生的定性访谈来定义创伤后应激障碍。 病人及家属的姑息治疗需要;及3）进行一项初步随机试验， 干预措施的可行性和初步疗效，以改善患者及其家属的姑息治疗后， 病人从重症监护室转到重症监护室 环境：华盛顿大学（UW）是Long博士研究培训的理想场所。UW是一个 杰出的生物医学研究机构，坚定地致力于促进学术事业， 有前途的调查员UW肺部和重症监护医学部因其 临床研究培训轨道，并提供了一个支持技能发展的智力环境 取得学术成就的必要条件。除了该司内部提供的资源外，朗博士还将 我也得到了华盛顿大学坎比亚姑息治疗卓越中心的全力支持（由她的主要负责人指导）。 导师），并将获得临床研究和生物统计支持，通过华盛顿大学公共学院 健康和转化健康科学研究所（临床和转化科学奖 在UW）。

项目成果

Aligning Intention and Effect: What Can We Learn From Family Members' Responses to Condolence Letters?

协调意图和效果：我们可以从家属对吊唁信的回应中学到什么？

• DOI: 10.1097/ccm.0000000000002738
• 发表时间: 2017
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Long,AnnC;Curtis,JRandall
• 通讯作者: Curtis,JRandall

Palliative Care Consultation and Family-Centered Outcomes in Patients With Unplanned Intensive Care Unit Admissions.

计划外入住重症监护室患者的姑息治疗咨询和以家庭为中心的结果。

• DOI: 10.1089/jpm.2023.0436
• 发表时间: 2023
• 期刊: Journal of palliative medicine
• 影响因子: 2.8
• 作者: Nomitch,JamieT;Downey,Lois;Pollack,LaurenR;Bayomy,OmarF;Ramos,KathleenJ;Kross,ErinK;Jennerich,AnnL
• 通讯作者: Jennerich,AnnL

Body Mass Index Recovery after Lung Transplant for Cystic Fibrosis.

囊性纤维化肺移植后体重指数恢复。

• DOI: 10.1513/annalsats.202108-969oc
• 发表时间: 2022
• 期刊: Annals of the American Thoracic Society
• 影响因子: 8.3
• 作者: Pryor,JosephB;Bradford,MirandaC;Jennerich,AnnL;Wai,TravisYHee;Pilewski,JosephM;Kapnadak,SiddharthaG;Aitken,MoiraL;Goss,ChristopherH;Ramos,KathleenJ
• 通讯作者: Ramos,KathleenJ

Before-After Study of a Checklist to Improve Acute Care to ICU Handoffs.

改善急诊护理至 ICU 交接的清单的前后研究。

• DOI: 10.1097/jmq.0000000000000091
• 发表时间: 2023
• 期刊: American journal of medical quality : the official journal of the American College of Medical Quality
• 作者: Hicks,KatherineG;Downey,Lois;Elketami,Addy;Nielsen,ElizabethL;Engelberg,RuthA;Jennerich,AnnL
• 通讯作者: Jennerich,AnnL

Validation of the French 3-year prognostic score for death or lung transplant in the United States cystic fibrosis population.

• DOI: 10.1016/j.jcf.2021.08.008
• 发表时间: 2022-05
• 期刊: Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society
• 作者: Ramos KJ;Wai TH;Sykes J;Ma X;Stephenson AL;Jennerich AL;Kapnadak SG;Mayer-Hamblett N;Goss CH
• 通讯作者: Goss CH