Describing, Contrasting, and Visualizing End-of-Life Care in the 21st Century

描述、对比和形象化 21 世纪的临终关怀

• 批准号: 8159505
• 负责人: GAIL M KEENAN
• 金额: $ 50.1万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-09 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8159505
• 关键词: Acute; Admission activity; Adverse event; Anxiety; Benchmarking; Cardiopulmonary; Care given by nurses; Caring; Cessation of life; Code; Computers; Data; Data Set; Databases; Diagnosis; Discipline of Nursing; Effectiveness; Electronic Health Record; Electronics; Evidence based practice; Family; Feedback; Focus Groups; Future; Goals; Hospital Units; Hospitalization; Hospitals; Hour; Imagery; Informatics; Intervention; Knowledge; Length of Stay; Life; Measurement; Medicare; Methods; Nurses; Nursing Diagnosis; Outcome; Pain; Pain management; Patients; Pattern; Persons; Practice based research; Process; Provider; Recording of previous events; Records; Risk; Sampling; Specific qualifier value; System; Terminology; Testing; Time; Translating; Videotape; Visual; base; care episode; clinical Diagnosis; clinically significant; data mining; demographics; end of life; fall risk; hospice environment; innovation; iterative design; meetings; nutrition; point of care; prospective; simulation; tool; usability

DESCRIPTION (provided by applicant): Our long-term goal is to reveal benchmarks and best practices for end-of-life (EOL) nursing care that support patients' dignity and comfort. Millions of dollars are spent each year on treatments of questionable value to hospitalized patients who are near death. The maturation of the electronic health records (EHRs) and standardized terminologies now make it possible to capture data and use it to determine the benchmarks and best practices of effective care or risks for adverse events. In our preliminary study of an extensive HANDS database of actual nursing care practices with 39,322 care episodes, we identified 1,394 EOL patients and we examined their "pain care" to demonstrate the feasibility of our methods and adequacy of power to determine effective pain benchmarks. This study yielded 4 statistically significant and clinically important benchmarks: (1) 51% of EOL patients failed to meet expected pain outcomes at discharge to hospice or death; (2) pain control achieved in the first 24 hours of care was predictive of pain control for the entire stay; (3) EOL patients with both cardiopulmonary and pain diagnoses had significantly poorer pain outcomes than those who do not; and (4) certain interventions were more likely to achieve pain control. We translated these pain benchmarks into an EHR user interface that is now ready for usability testing by a prospective sample. Building on these important findings, we propose to identify benchmarks and best practices for 5 additional care problems and 5 combinations of problems that are common to hospitalized EOL patients. From the validated dataset of care plan histories for 1,394 EOL patients from 8 different acute care units in 4 Midwestern hospitals, we will characterize EOL care using the following attributes: 1) patient and provider demographics; and 2) the nursing diagnoses, interventions, and outcomes as they evolved during each patient's care episode. Once we determine the benchmarks, then we will build a benchmarking system that presents the findings visually on EHR computer screens that help nurses to see and use the benchmarks as they plan and document care in the EHR. Our specific aims are to: Aim1. Determine patterns among all attributes recorded in HANDS for meaningful associations among the attributes that reveal benchmarks and best practices. Aim 2. In a diverse sample of 75 nurses, determine the usability (accessibility, visual appeal, content utility to guide intended use at the point of care) of new visualization screens that display the benchmarks for outcome pattern ratings (at the level of the person, unit, hospital, and across the 4 hospitals) and best practices. Study findings will inform future prospective practice-based research to verify the effectiveness of the benchmarking system to produce desired outcomes for hospitalized EOL patients. Such findings are urgently needed to enable best practice nursing care that supports hospitalized EOL patients' dignity and comfort as they die. PUBLIC HEALTH RELEVANCE: In this study, information that nurses document in EHRs will be used to discover the best treatments to support the dignity and comfort of dying patients and their families. We will then take the new knowledge and build and test EHR innovations that will make sure nurses use the knowledge when caring for dying patients.

描述（由申请人提供）：我们的长期目标是揭示支持患者尊严和舒适的临终（EOL）护理的基准和最佳实践。每年花费数百万美元用于治疗濒临死亡的住院病人，但其价值值得怀疑。电子健康记录（EHR）和标准化术语的成熟，现在可以捕获数据并使用它来确定有效护理或不良事件风险的基准和最佳实践。在我们对包含39，322次护理事件的实际护理实践的广泛HANDS数据库的初步研究中，我们确定了1，394名EOL患者，并检查了他们的“疼痛护理”，以证明我们的方法的可行性和确定有效疼痛基准的充分性。该研究产生了4个具有统计学显著性和临床重要性的基准：（1）51%的EOL患者在出院至临终关怀或死亡时未能达到预期的疼痛结局;（2）在护理的前24小时内实现的疼痛控制可预测整个住院期间的疼痛控制;（3）具有心肺和疼痛诊断的EOL患者的疼痛结局显著差于那些没有心肺和疼痛诊断的患者;和（4）某些干预措施更有可能实现疼痛控制。我们将这些痛苦基准转换为EHR用户界面，现在可以通过预期的样本进行可用性测试。基于这些重要的发现，我们建议确定基准和最佳实践的5个额外的护理问题和5个组合的问题，是常见的住院EOL患者。根据来自4家中西部医院的8个不同急症室的1，394名EOL患者的护理计划历史的经验证数据集，我们将使用以下属性来表征EOL护理：1）患者和提供者人口统计学;以及2）护理诊断，干预措施和结局，因为它们在每个患者的护理事件中演变。一旦我们确定了基准，我们将建立一个基准系统，在EHR计算机屏幕上直观地呈现结果，帮助护士在EHR中计划和记录护理时查看和使用基准。我们的具体目标是：目标1。确定HANDS中记录的所有属性之间的模式，以便在揭示基准和最佳实践的属性之间建立有意义的关联。目标二。在75名护士的多样化样本中，确定新可视化屏幕的可用性（可访问性、视觉吸引力、指导护理点预期用途的内容实用性），这些屏幕显示结果模式评级（在个人、单位、医院和4家医院的水平）和最佳实践的基准。研究结果将为未来基于实践的前瞻性研究提供信息，以验证基准系统的有效性，从而为住院的EOL患者产生预期的结局。迫切需要这些发现来实现最佳实践护理，以支持住院的EOL患者在死亡时的尊严和舒适。 公共卫生关系：在这项研究中，护士在电子病历中记录的信息将被用来发现最好的治疗方法，以支持垂死患者及其家属的尊严和舒适。然后，我们将采用新知识，建立和测试EHR创新，以确保护士在护理垂死患者时使用这些知识。