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

对患者体验进行分层检查，以阐明姑息治疗在重病老年人手术治疗中的作用

• 批准号: 10588875
• 负责人: Zara R Cooper
• 金额: $ 11.55万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588875
• 关键词: Admission activity; Caregivers; Caring; Clinical; Colectomy; Coronary Artery Bypass; Data; Data Sources; Documentation; Elderly; Ethnography; Goals; Health and Retirement Study; Health system; Healthcare; Intervention; Interview; Link; Lower Extremity; Medicare claim; Mental Depression; Methods; Natural Language Processing; Observational Study; Operative Surgical Procedures; Outcome; Pain; Palliative Care; Patient-Focused Outcomes; Patients; Perioperative; Play; Process; Proxy; Qualitative Research; Research; Research Methodology; Retrospective cohort; Role; Testing; Trauma; Trauma patient; Work; caregiving; clinical care; clinical practice; cohort; contextual factors; experience; health care service utilization; health data; hip replacement arthroplasty; implementation barriers; improved; novel; older patient; parent grant

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.

项目摘要 博士Hiba Dhanani将通过多样性补充的支持获得宝贵的研究经验， 家长补助金，“一个分层检查的病人的经验，以阐明姑息治疗的作用， 老年重症患者的外科护理（LEAPS）。LEAPS研究使用补充数据源， 评估以患者为中心的结果，在老年重病手术患者，使用新的方法来评估 姑息治疗过程对结果的影响，并深入探讨了实施 围手术期姑息治疗的临床实践。目标1确定直接目标之间的关联， 姑息治疗（疼痛、抑郁和缓解需求）和较不近的好处（减少医疗保健） 利用），以证明姑息治疗在外科手术中的重要作用。我们将使用来自健康和 退休研究（2004-2018年），以确定一个因严重疾病而入院的老年外科患者（≥ 66岁）队列， 大手术或创伤，然后将这些数据联系起来，以检查下游医疗保健的使用情况。目标2是一个 回顾性队列，老年重症外科患者（≥ 66岁）因结肠切除术，髋关节置换术， 冠状动脉旁路移植术（CABG）或下肢血管重建术） 在2016-2019年期间，在电子健康数据中使用自然语言处理来识别姑息治疗 过程（护理讨论的目标、医疗保健代理文件、疼痛和护理人员评估） 在手术过程中输送的然后，这些数据将与医疗保险索赔相关联， 在外科住院期间接受的姑息治疗与医疗保健之间的独立关联 手术后一年的使用率。目标3使用定性访谈的人种志分析 和直接观察，以深入了解影响执行的背景因素 重症老年患者（≥65岁）在整个手术期间的临床护理中的姑息治疗过程 插曲。这些研究的结果将直接为床边临床决策和 有针对性的姑息治疗干预措施，以改善对重症老年手术患者的护理。达纳尼博士将 在研究目标1和2中发挥主要作用，并对创伤患者进行具体分析。她将主持 目标3早期重要工作，熟悉人种学观察和定性研究 方法.