A Layered Examination of the Patient Experience to Elucidate the Role of Palliative Care in Surgical Care for Seriously Ill Older Adults

项目摘要 Hiba Dhanani博士将通过支持多样性补充方案获得宝贵的研究经验 Parent Grant，《对患者经历的分层检查，以阐明姑息治疗在 《老年重症患者的外科治疗》(《LEAPS》)。LEAPS研究使用补充数据源来 评估以患者为中心的老年重症手术患者的结果，使用新方法评估 姑息治疗过程对结果的影响，并深入审查实施 临床实践中的围手术期姑息护理。目标1确定的直接目标之间的关联 姑息治疗(疼痛、抑郁和护理需求)和较少的近期好处(减少医疗保健 利用)来证明姑息治疗在外科手术中的重要作用。我们将使用来自卫生与公众服务部的数据 退休研究(2004年至2018年)以确定一组因严重疾病而入院的老年外科患者(≥66y) 大手术或创伤，然后将这些数据联系起来，检查下游的医疗保健使用情况。目标2是一个 老年重症外科患者(≥66y)入院(结肠切除，髋关节置换， 大型区域卫生系统中的冠状动脉搭桥术(CABG)或下肢血管重建术 并在电子健康数据中使用自然语言处理来识别姑息治疗 流程(护理讨论、医疗代理文档、疼痛和护理者评估的目标) 在手术期间接生的。然后这些数据将被链接到联邦医疗保险声明以进行测试 手术入院期间接受的姑息治疗与医疗保健之间的独立关联 手术出院后一年内的使用情况。目标3使用定性访谈的民族志分析 和直接观察，以获得对影响执行的背景因素的深入了解 在整个外科手术中对重病老年患者(≥65岁)的临床护理中姑息护理过程的评价 这一集。这些研究的结果将直接为床边临床决策和实施 有针对性的姑息治疗干预措施，以改善对重病老年手术患者的护理。达纳尼博士会 在研究目标1和2中发挥主要作用，并针对创伤患者进行具体分析。她将指挥 目标3中重要的早期工作，以熟悉人种学观察和定性研究 方法：研究方法。

Project Summary Dr. Hiba Dhanani will gain valuable research experience through the support of a diversity supplement to the parent grant, “A Layered Examination of the Patient Experience to Elucidate the Role of Palliative Care in Surgical Care for Seriously Ill Older Adults” (“LEAPS”). The LEAPS study uses complementary data sources to assess patient-centered outcomes in older seriously ill surgical patients, uses novel methods to evaluate the impact of palliative care processes on outcomes, and deeply examines barriers to implementation of perioperative palliative care in clinical practice. Aim 1 determines the association between direct targets of palliative care (pain, depression, and caregiving needs) and less proximal benefits (reduced healthcare utilization) to demonstrate the important role of palliative care in surgery. We will use data from the Health and Retirement Study (2004-2018) to identify a cohort of seriously ill older surgical patients (≥66y) admitted for a major surgery or trauma, and then link these data to examine downstream healthcare use. Aim 2 is a retrospective cohort of older seriously ill surgical patients (≥66y) admitted for (colectomy, hip replacement, coronary artery bypass (CABG), or lower extremity revascularization) in a large regional health system between 2016-2019 and uses Natural Language Processing in electronic health data to identify palliative care processes (goals of care discussions, healthcare proxy documentation, pain, and caregiver assessments) delivered during the surgical episode. These data will then be linked to Medicare claims to test independent associations between palliative care received during the surgical admission and healthcare utilization in the year after surgical discharge. Aim 3 uses ethnographic analysis of qualitative interviews and direct observations to obtain an in-depth understanding of contextual factors influencing implementation of palliative care processes in the clinical care of seriously ill older patients (≥65 years) throughout the surgical episode. Results from these studies will directly inform bedside clinical decisions and the implementation of targeted palliative care interventions to improve care for seriously ill older surgical patients. Dr. Dhanani will play a major role in study aims 1 and 2 and conduct analyses specific to trauma patients. She will conduct important early work in aim 3 to become familiar with ethnographic observations and qualitative research methods.