Temporal trends in quality indicators of palliative care for patients with chronic illness hospitalized with acute respiratory failure

项目摘要/摘要 慢性疾病患者如果出现急性呼吸衰竭，将面临严重的发病率和死亡率， 幸存者往往遭受严重的身体和心理后遗症。这些患者迫切需要 姑息治疗。姑息治疗的重点是提高患者和患者家属的生活质量 通过提供高质量的沟通、症状控制以及情感和精神支持，为严重疾病提供帮助。 尽管这种类型的护理有多么重要，但关于姑息治疗质量的信息很少。 为患有急性呼吸衰竭的慢性病患者提供的护理。如果没有这方面的知识，它是非常 开发有效的干预措施以提高以患者和家庭为中心的结果具有挑战性 人口。 为了填补这一关键知识空白，我将使用明确定义的、可测量的项目来详细说明流程， 结果，和结构的姑息治疗，以实现我的主要目标，研究时间趋势 过去十年的姑息治疗，包括对自 新冠肺炎大流行的开始。我已经确定了一组超过16,000名慢性、限制生命的患者 2012年至2022年期间因急性呼吸衰竭住院。使用这个队列，我将实现我的 主要目标通过两个具体目标。目标1将审查质量指标的时间趋势 2012-2022年间因急性呼吸衰竭住院的慢性病患者的姑息治疗。 目标2将评估住院慢性病患者姑息治疗质量指标的差异 与急性呼吸衰竭患者相比，在2020年间，服用新冠肺炎的患者和没有服用新冠肺炎的患者- 2022年 通过实现提议的目标，我将发现随着时间的推移，护理方面的改善、停滞和下降 跨多个姑息治疗领域的特定过程和结果指标，突出重大变化 发生在新冠肺炎大流行期间，并确定姑息治疗质量指标的差异 那些有新冠肺炎和没有新冠肺炎的人。建议项目的结果将为我未来的研究提供信息，以描述 这些趋势背后的机制，目的是制定有效的干预措施以改善护理 为患有慢性、限制生命的疾病和急性呼吸衰竭的成年人提供分娩服务。

PROJECT SUMMARY/ABSTRACT Patients with chronic illness who develop acute respiratory failure face significant morbidity and mortality, with survivors often suffering serious physical and psychological sequelae. These patients have a critical need for palliative care. Palliative care is focused on improving quality of life for both patients and family of patients with serious illness by providing high-quality communication, symptom control, and emotional and spiritual support. Despite how important this type of care is, there is little information available regarding the quality of palliative care provided to chronically ill patients with acute respiratory failure. Without this knowledge, it is extremely challenging to develop effective interventions to enhance patient- and family-centered outcomes for this population. To fill this key knowledge gap, I will use explicitly defined, measurable items that detail the processes, outcomes, and structure of palliative care to achieve my primary objective of examining temporal trends in palliative care over the last decade, including an assessment of changes that have occurred since the inception of the COVID-19 pandemic. I have identified a cohort of over 16,000 patients with chronic, life-limiting illness hospitalized with acute respiratory failure between 2012 and 2022. Using this cohort, I will achieve my primary objective through two specific aims. Aim 1 will examine temporal trends in quality indicators of palliative care for patients with chronic illness hospitalized with acute respiratory failure between 2012-2022. Aim 2 will assess differences in quality indicators of palliative care for patients with chronic illness hospitalized with acute respiratory failure, comparing patients with COVID-19 to those without COVID-19, between 2020- 2022. By accomplishing the proposed aims, I will identify improvement, stagnation, and decline in care over time in specific process and outcome metrics across multiple palliative care domains, highlighting significant changes occurring during the COVID-19 pandemic and identifying differences in quality indicators of palliative care for those with and without COVID-19. Results from the proposed project will inform my future research to describe mechanisms underlying these trends, with the goal of developing effective interventions to improve care delivery for adults with chronic, life-limiting illness and acute respiratory failure.