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

项目总结/摘要 发生急性呼吸衰竭的慢性病患者面临显著的发病率和死亡率， 幸存者往往遭受严重的身心后遗症。这些患者迫切需要 姑息治疗姑息治疗的重点是改善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，帮助患者治疗严重疾病。 尽管这种类型的护理是多么重要，但有关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护理。如果没有这些知识， 制定有效的干预措施，以加强以患者和家庭为中心的结果， 人口 为了填补这一关键的知识空白，我将使用明确定义的、可衡量的项目来详细说明流程， 结果和姑息治疗的结构，以实现我的主要目标，检查时间趋势， 过去十年的姑息治疗，包括评估自2010年以来发生的变化， COVID-19疫情开始。我已经确定了一个超过16,000名患有慢性，限制生命的 2012年至2022年因急性呼吸衰竭住院的疾病。利用这群人，我将实现我的 通过两个具体的目标。目标1将审查质量指标的时间趋势， 2012-2022年期间因急性呼吸衰竭住院的慢性病患者的姑息治疗。 目的2将评估慢性病住院患者姑息治疗质量指标的差异 急性呼吸衰竭，将COVID-19患者与非COVID-19患者进行比较，在2020年至2022年期间， 2022. 通过实现所提出的目标，我将确定随着时间的推移， 多个姑息治疗领域的具体过程和结果指标，突出显示重大变化 在COVID-19大流行期间发生的事件，并确定姑息治疗质量指标的差异， 无论是否感染了COVID-19。从拟议项目的结果将通知我未来的研究，以描述 这些趋势背后的机制，目标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.