Developing a Robust Measure of Hospital End-of-Life Intensity
制定医院临终强度的稳健衡量标准
基本信息
- 批准号:7915430
- 负责人:
- 金额:$ 14.27万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2009
- 资助国家:美国
- 起止时间:2009-08-15 至 2012-07-31
- 项目状态:已结题
- 来源:
- 关键词:AcuteAddressAdmission activityAmericanArtsBackBehaviorCancer PatientCaringCase SeriesCessation of lifeCharacteristicsClinicalClinical DataCost ControlDataDecision MakingElderlyEpidemiologyGoalsGoldHealth Care CostsHealth Services ResearchHospitalizationHospitalsIndividualIntensive CareKnowledgeLifeLinkMeasuresMedicalMedicareMethodsPatientsPatternPennsylvaniaPerformancePoliciesPopulationProbabilityProceduresProviderQuality of CareRaceReportingResearchResearch PersonnelRiskSeverity of illnessStructural ModelsSubgroupSurvival AnalysisSystemTechniquesTimeVariantVital Statisticsabstractingbasebeneficiarycohortend of lifefollow-upimprovedoutcome forecastperformance testsstem
项目摘要
DESCRIPTION (provided by applicant): Several researchers have argued that the high intensity of medical care that elderly Medicare beneficiaries receive at the end of life is a potential indicator of poor quality of care and of inefficiency. However, the traditional method for measuring intensity of treatment through the decedent follow-back (case-series) approach may be flawed. Specifically, many decedents were not known to be "dying" and that intensive treatment for them may be appropriate; instead, the goal is to identify patients with poor prognosis for whom intensive care may have low marginal value. We have developed a new measure of end-of-life intensity that focuses on treatment patterns among patients with a high probability of dying (HPD), defined as admissions in the 95th percentile of predicted probability of death. Our HPD measure is a theoretically less biased estimate of decision making for "dying" patients; it compares similar populations across hospitals, and it may be a marker of inefficiency. We plan to use our HPD intensity measure to further elucidate the causes and consequences of race- and condition-specific variations in decision making near the end of life by studying the contribution of individual hospital behavior to these patterns. Blacks have higher rates of life-sustaining treatment (LST) use and patronize hospitals with greater ICU use, and in the aggregate, cancer patients are much less likely than non-cancer patients with serious life limiting illness to receive end-of-life ICU care. Second, we seek to test the performance characteristics of our HPD measure across racial groups and conditions to ascertain whether the measure should be calculated and reported separately for patient subgroups. Third, we seek to explore the generalizability of the HPD approach to the vast majority of administrative data lacking the clinical and risk prediction data available in Pennsylvania. Our aims are:1) To calculate race-specific measures of hospitals' end-of-life treatment intensity and explore the relationship between a hospital's race-specific intensity and post-admission survival; 2) To calculate condition-specific measures of hospitals' end-of-life treatment intensity and explore the relationship between a hospital's condition-specific intensity and post-admission survival; and 3) To develop an administrative data-derived HPD measure and compare it to our "gold standard" clinical data-augmented HPD measure. All analyses will use Pennsylvania Health Care Cost Containment Council data linked to state vital statistics data. Our proposed statistical procedures for developing hospital-specific intensity measures will rely on state-of-the-art Bayesian techniques, and survival analyses will extend to health services research the marginal structural models originally developed in epidemiology to address time-varying confounders. The new measure we seek to refine has the potential to fill a niche in current policy efforts to publicly profile hospitals' performance and to help us better understand how decisions to use intensive care and LST vary by race and condition.
描述(由申请人提供):几位研究人员认为,老年医疗保险受益人在生命末期接受的高强度医疗护理是护理质量差和效率低下的潜在指标。然而,通过死亡随访(病例系列)方法来衡量治疗强度的传统方法可能是有缺陷的。具体地说,许多死者并不知道正在“死亡”,对他们进行强化治疗可能是合适的;相反,目标是找出预后较差的患者,对他们来说,重症监护的边际价值可能很低。我们开发了一种新的临终强度测量方法,重点是死亡概率(HPD)高的患者的治疗模式,定义为在预测死亡概率的第95个百分位数入院。我们的HPD测量在理论上是对“垂死”患者决策的一种较少偏见的估计;它比较不同医院的相似人群,它可能是低效的标志。我们计划使用我们的HPD强度测量方法,通过研究个别医院行为对这些模式的贡献,进一步阐明在生命接近尾声时,种族和条件特定的决策差异的原因和后果。黑人有更高的生命维持治疗(LST)使用率,并光顾ICU使用率更高的医院,总的来说,癌症患者接受临终ICU护理的可能性比患有严重生命限制疾病的非癌症患者低得多。其次,我们试图测试我们的HPD测量在不同种族和条件下的表现特征,以确定是否应该为患者亚组单独计算和报告该测量。第三,我们试图探索HPD方法对宾夕法尼亚州绝大多数缺乏临床和风险预测数据的管理数据的普适性。我们的目标是:1)计算医院临终治疗强度的种族特定测量,并探索医院种族特定强度与入院后生存之间的关系;2)计算医院临终治疗强度的特定条件测量,并探索医院条件特定强度与入院后生存之间的关系;以及3)开发基于管理数据的HPD测量,并将其与我们的临床数据增强的金标准HPD测量进行比较。所有分析都将使用宾夕法尼亚州医疗成本控制委员会的数据,这些数据与州生命统计数据相关联。我们建议的针对特定医院强度测量的统计程序将依赖于最先进的贝叶斯技术,生存分析将扩展到卫生服务研究最初在流行病学中开发的边缘结构模型,以解决时变的混杂因素。我们寻求完善的新措施有可能填补当前政策努力中的一个利基市场,公开介绍医院的表现,并帮助我们更好地了解使用重症监护和LST的决定如何因种族和条件而异。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
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AMBER E BARNATO其他文献
AMBER E BARNATO的其他文献
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{{ truncateString('AMBER E BARNATO', 18)}}的其他基金
Empirical Classification of the Typologies of Hospital Deaths
医院死亡类型的实证分类
- 批准号:
10261322 - 财政年份:2020
- 资助金额:
$ 14.27万 - 项目类别:
Using behavioral economics to understand end-of-life decisions
使用行为经济学来理解临终决策
- 批准号:
8033543 - 财政年份:2010
- 资助金额:
$ 14.27万 - 项目类别:
ICU Triage Decisions for Elders with End Stage Cancer: the Role of Patient Race
重症监护病房 (ICU) 对晚期癌症老年人的分诊决策:患者种族的作用
- 批准号:
7641310 - 财政年份:2009
- 资助金额:
$ 14.27万 - 项目类别:
ICU Triage Decisions for Elders with End Stage Cancer: the Role of Patient Race
重症监护病房 (ICU) 对晚期癌症老年人的分诊决策:患者种族的作用
- 批准号:
7799225 - 财政年份:2009
- 资助金额:
$ 14.27万 - 项目类别:
Isolating Mechanisms Underlying Hospital Variation in End-of-Life ICU Use
临终 ICU 使用中医院差异的隔离机制
- 批准号:
7707711 - 财政年份:2009
- 资助金额:
$ 14.27万 - 项目类别:
Developing a Robust Measure of Hospital End-of-Life Intensity
制定医院临终强度的稳健衡量标准
- 批准号:
8102792 - 财政年份:2009
- 资助金额:
$ 14.27万 - 项目类别:
Developing a Robust Measure of Hospital End-of-Life Intensity
制定医院临终强度的稳健衡量标准
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7559808 - 财政年份:2009
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- 批准号:
7618173 - 财政年份:2008
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Provider and Organizational Norms and Care at End of Life (PONCEL): A Study of Tw
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7383303 - 财政年份:2008
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SMDM 年会癌症决策工具研讨会
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7000940 - 财政年份:2005
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$ 14.27万 - 项目类别:
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