Use of Inter-Hospital Transfer Services in Critical Illness and Acute Respiratory Failure

在危重疾病和急性呼吸衰竭中使用医院间转运服务

• 批准号: 10739060
• 负责人: Christopher Moore Worsham
• 金额: $ 15.57万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739060
• 关键词: Use; Inter; Hospital; Transfer; Services

PROJECT SUMMARY/ABSTRACT This K08 award will establish Christopher Worsham, MD, MPH as a clinician-investigator health services researcher examining critical care services and their value using advanced methods of causal inference. Dr. Worsham is an Instructor in Medicine, pulmonologist, and critical care physician at Harvard Medical School and Massachusetts General Hospital. Building on his clinical training, prior research experience, and coursework in quantitative methods, this award will allow him to develop expertise in (1) advanced methods of causal inference using large administrative datasets, (2) inter-hospital critical care transport services with an emphasis on acute respiratory failure (ARF), and (3) decision science and cost- effectiveness analysis. To achieve these goals, Dr. Worsham has assembled a team with expertise in: health services research and advanced methods of causal inference (Drs. Anupam Jena, Mary Beth Landrum, Hannah Wunsch, and Bruce Landon); critical care medicine and ARF (Dr. Taylor Thompson); critical care transport in ARF (Dr. Susan Wilcox); and decision science and cost-effectiveness analysis (Dr. Ankur Pandya). The inter-hospital transfer of critically ill patients is a common practice in the U.S. critical care system, generally done to move patients to hospitals with intensive care unit (ICU) resources commensurate with the severity of their acute illness. However, we do not fully understand current national practice patterns of inter- hospital ICU transfer across diverse patient populations. We also lack robust estimates of clinical benefits or value of using particularly costly air ambulance services to rapidly move ICU patients between hospitals, including those with ARF, the most common reason for ICU admission. To address these important questions in the critical care system, Dr. Worsham will analyze data from two large insurance claims databases, Medicare and the MarketScan commercial insurance claims database. In Aim 1, he will characterize current practices and risk factors associated with inter-hospital ICU transfer in the overall adult ICU population. In Aim 2, focusing on patients with ARF, he will estimate the effect of air compared to ground inter-hospital transport using a novel instrumental variables approach that accounts for unmeasured confounding by taking advantage of the random weather conditions that push patients to travel by ground rather than air. In Aim 3, he will use methods of decision science to perform a cost-effectiveness analysis of air compared to ground inter-hospital transport of patients with ARF to inform high-value care. This work and training will provide him the basis for a future R01 proposal that examines common and costly practices that impact patients as they move through the U.S. critical care system using advanced methods of causal inference and cost-effectiveness analysis. This K08 and future R01 will inform bedside decision making and policy surrounding resource allocation and high-value care in the U.S. critical care system.

项目总结/摘要 这个K 08奖将建立克里斯托弗Worsham，医学博士，公共卫生硕士作为临床研究者健康 服务研究人员使用因果关系的先进方法检查重症监护服务及其价值 推论Worsham博士是哈佛大学的医学讲师、肺病学家和重症监护医生 医学院和马萨诸塞州总医院。根据他的临床训练和先前的研究 经验，并在定量方法的课程，这个奖项将使他发展的专业知识（1） 使用大型管理数据集进行因果推理的先进方法，（2）医院间重症监护 交通服务，重点是急性呼吸衰竭（ARF），（3）决策科学和成本- 有效性分析为了实现这些目标，Worsham博士组建了一个具有以下专业知识的团队： 服务研究和因果推理的先进方法（Anupam Jena博士，玛丽贝丝兰德鲁姆， Hannah Wunsch和布鲁斯兰登）;重症监护医学和ARF（泰勒汤普森博士）;重症监护 非洲区域论坛的运输（Susan Wilcox博士）;以及决策科学和成本效益分析（Ankur Pandya博士）。 重症患者的院间转移是美国重症监护系统的常见做法， 通常将患者转移到具有与患者的需求相称的重症监护室（ICU）资源的医院。 他们急性疾病的严重程度。然而，我们并不完全了解目前国家间的做法模式， 医院ICU在不同患者人群之间转移。我们还缺乏对临床获益的可靠估计， 使用特别昂贵的空中救护服务在医院之间快速运送ICU患者的价值， 包括ARF患者，这是ICU入院的最常见原因。 为了解决重症监护系统中的这些重要问题，Worsham博士将分析来自 两个大型保险索赔数据库，医疗保险和MarketScan商业保险索赔数据库。 在目标1中，他将描述与医院间ICU转移相关的当前实践和风险因素， ICU的所有成年人在目标2中，关注ARF患者，他将估计空气的影响， 与地面医院间转运相比，使用一种新的工具变量方法， 通过利用随机天气条件推动患者旅行， 地面而不是空中。在目标3中，他将使用决策科学的方法来执行成本效益 对ARF患者的空中与地面医院间转运进行比较分析，以提供高价值护理信息。这 工作和培训将为他提供未来R 01提案的基础，该提案将审查通用和昂贵的 实践，影响病人，因为他们通过美国重症监护系统使用先进的方法， 因果推理和成本效益分析。本K 08和未来的R 01将为床旁决策提供信息 以及美国重症监护系统中围绕资源分配和高价值护理的政策。