Abdominal Pain in Older Patients in Emergency Departments

急诊科老年患者的腹痛

• 批准号: 10739136
• 负责人: Ari B Friedman
• 金额: $ 19.49万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739136
• 关键词: Abdomen; Abdominal Pain; Abdominal Radiography; Accident and Emergency department; Acute; Acute Disease; Admission activity; Adult; Affect; Age; Aging; Alzheimer' s disease related dementia; Analgesics; Award; Benign; Biological Models; Caring; Cessation of life; Cognitive; Communication Barriers; Data; Data Collection; Data Sources; Delirium; Dementia; Development Plans; Diagnosis; Diagnostic tests; Disease; Disparity population; Doctor of Philosophy; Elderly; Electrocardiogram; Electronic Health Record; Emergency Care; Emergency Department Physician; Emergency Department patient; Emergency Medicine; Emergency department visit; Emergent care; Enrollment; Environment; Equilibrium; Evaluation; Face; Faculty; Fostering; Funding; Future; Geriatrics; Gerontology; Goals; Health; Health Services Research; Hospitalization; Hospitals; Impaired cognition; Infection; Infrastructure; Institution; Intestinal Obstruction; Ischemia; K-Series Research Career Programs; Knowledge; Link; Longitudinal cohort; Measurement; Measures; Mediating; Medical; Medicare; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Mesentery; Morbidity - disease rate; Myocardial Infarction; Natural History; Neurocognitive; Outcome; Pain; Pathway interactions; Patient Admission; Patient Care; Patients; Patterns of Care; Pennsylvania; Persons; Physical Function; Physiological; Quality of Care; Race; Research; Research Personnel; Resources; Risk; Scholarship; Science; Secure; Sociology; Source; Structure; Symptoms; Syndrome; System; Testing; Time; Training; Trauma; Triage; Universities; Variant; Visit; Work; X-Ray Computed Tomography; care seeking; care systems; career; career development; clinical practice; cognitive function; cohort; disparity reduction; emergency settings; frailty; health disparity; health economics; high risk; human old age (65+); improved; mild cognitive impairment; mortality; mortality risk; multiple chronic conditions; older patient; pain patient; patient population; patient subsets; poor health outcome; prospective; sex; side effect; skill acquisition; skills; success

PROJECT SUMMARY/ABSTRACT Candidate: Ari B. Friedman, MD, PhD is junior faculty at the University of Pennsylvania (Penn). He practices clinically as an emergency physician and conducts research as a health economist into how care systems affect patients' lives. He is passionate about improving the care and outcomes of the many older patients that he sees in the emergency department (ED) by improving the science underlying that care. Goal: The purpose of this K23 Career Development Award is to enable Dr. Friedman to gain knowledge and skills necessary to become an independent investigator focusing on the emergent care of older patients. Research Context: Visits to hospital EDs are a growing source of care for adults over 65, totaling 22.4 million visits in 2017. Among older patients, abdominal pain is the single most common chief complaint. Simply being over 65 years, presenting to an ED, and stating at triage, “I have abdominal pain,” as a chief complaint confers a mortality rate as high or higher than an ST-Elevation Myocardial Infarction (STEMI), with equivalently high morbidity. Yet little is known about this phenomenon, especially for patients with frailty or cognitive impairment. Career Development Plan: Dr. Friedman seeks training in frailty, cognitive impairment and dementia, geriatrics, primary data collection, and health disparities. This award will provide protected time for Dr. Friedman to acquire the skills necessary to secure independent funding through a progressive, milestone- driven training plan that includes coursework, mentored research, and guided independent study. Aims: The central hypothesis of this proposal is that there are identifiable ways to improve the evaluation and management of abdominal pain among older patients in the ED. Dr. Friedman will use the training funded by this Mentored Patient-Oriented Research Career Development Award to examine variation in ED abdominal pain testing, management, disposition, and outcomes overall and among patients with frailty, cognitive impairment, among disadvantaged populations, and in periods when resources do not meet demand. Research Plan: These Aims will be carried out by using primary data collected through the proposed ED Geriatric Abdominal Pain (ED-GAP) cohort with additional variables from the Penn Electronic Health Record (EHR). This data will capture both management and outcomes for admitted patients and contains measurements of essential factors associated with aging. Retrospective EHR data of abdominal pain visits to 6 EDs over 8 years will also be used. Multivariate regression will test the hypotheses above. Environment: Senior researchers with an established track record of mentoring scholars from their early career to independent and impactful work are committed to Dr. Friedman's success. This team is embedded within a university environment with a track record of collaborative, pathbreaking scholarship in health economics, health services research, emergency medicine, and gerontology.

项目总结/摘要 候选人：阿里B。Friedman，MD，PhD是宾夕法尼亚大学（Penn）的初级教师。球员训练 临床上作为急诊医生，并进行研究，作为一个健康经济学家如何照顾系统 影响患者的生活。他热衷于改善许多老年患者的护理和结果， 他在急诊科（艾德）看到的，通过提高科学基础的护理。 目标：K23职业发展奖的目的是让Friedman博士获得知识并 必要的技能，成为一个独立的调查员，专注于老年患者的紧急护理。 研究背景：访问医院急诊室是65岁以上成年人越来越多的护理来源，总计2240万 2017年访问。在老年患者中，腹痛是最常见的主诉。简单地 65岁以上，到艾德就诊，并在分诊时陈述“我有腹痛”，作为主诉， 死亡率与ST段抬高型心肌梗死（STEMI）一样高或更高， 发病率然而，人们对这种现象知之甚少，特别是对于虚弱或认知障碍的患者。 职业发展计划：弗里德曼博士寻求在脆弱，认知障碍和痴呆症的培训， 老年医学、原始数据收集和健康差异。该奖项将为博士提供保护时间。 弗里德曼获得必要的技能，以确保独立的资金，通过一个渐进的，里程碑式的- 驱动的培训计划，包括课程，指导研究，并指导独立研究。 目的：本建议的核心假设是，有可识别的方法来改进评价， 弗里德曼博士将使用由教育部资助的培训， 这个指导以病人为导向的研究职业发展奖，以检查艾德腹部的变化， 疼痛测试、管理、处置和总体结局，以及虚弱、认知障碍、 在弱势群体中，以及在资源不能满足需求的时期，儿童的健康受到损害。 研究计划：这些目标将通过使用通过拟议的艾德收集的原始数据来实现 老年腹痛（ED-GAP）队列和来自Penn电子健康记录的其他变量 （EHR）。这些数据将记录入院患者的管理和结局， 与衰老相关的重要因素的测量。6例腹痛访视的回顾性EHR数据 还将使用8年以上的ED。多元回归将检验上述假设。 环境：资深研究人员，从他们的早期指导学者的既定记录 从职业生涯到独立和有影响力的工作都致力于弗里德曼博士的成功。这个团队是嵌入式的 在一个大学环境中，在健康领域有着合作、开创性的学术成就， 经济学、卫生服务研究、急救医学和老年学。