Delivering Hospice and Palliative Care Services to Nursing Home Patients

为疗养院患者提供临终关怀和姑息治疗服务

• 批准号: 9088261
• 负责人: Kathleen T Unroe
• 金额: $ 16.23万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9088261
• 关键词: Address; Aging; American; Award; Bereavement; Caring; Characteristics; Clinical; Clinical Research; Communication; Computerized Medical Record; Consult; Consultations; Data; Data Collection; Databases; Development Plans; Diagnosis; Discipline; Education; Eligibility Determination; Emotional; Enrollment; Evaluation; Extramural Activities; Family; Foundations; Funding; Future; Goals; Growth; Health; Home Nursing Care; Home environment; Hospice Care; Housing; Improve Access; Indiana; Individual; Industry; K-Series Research Career Programs; Knowledge acquisition; Life; Link; Marketing; Master' s Degree; Measures; Medicare; Mentors; Mentorship; Modeling; Movement; Nursing Homes; Outcome; Pain management; Palliative Care; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Perception; Population; Provider; Proxy; Qualifying; Quality of Care; Recommendation; Records; Reporting; Research; Research Personnel; Research Project Grants; Running; Seasons; Services; Shapes; Site; Source; Structure; Surveys; Testing; Time; Training; Training Activity; United States; Universities; Variant; Visit; Work; base; career; career development; clinical investigation; cost; design; end of life; evidence base; experience; holistic approach; hospice environment; individual patient; meetings; multidisciplinary; patient oriented; payment; personalized care; programs; research and development; skills; social; symptom treatment; volunteer

DESCRIPTION (provided by applicant): This application proposes a 5 year career development and research plan to support the candidate's acquisition of the knowledge and research skills needed to become an independent investigator in patient- oriented aging research. The career development plan designed by the candidate and her mentors is tailored to acknowledge the special skills, experiences, and relationships needed to build a research career focused in the nursing home setting. The training plan includes formal coursework to earn a Master's Degree in Clinical Research through the Indiana University Clinical Investigation and Translational Education (CITE) program, as well as extramural training activities to obtain additional expertise in palliative care and nursing home practice. The proposed research project, "Delivering Hospice and Palliative Care Services to Nursing Home Patients," will be conducted in partnership with a large multi-state hospice and palliative care provider, Seasons Hospice. We have access to the detailed patient care records of over 50,000 hospice patients enrolled from 2006-2012, as well as about 1,000 non-hospice palliative care consult patients. Nearly 1/3 of both the hospice patients and the palliative care consult patients in this database lived in nursing homes. The hospice records are linked to the Family Evaluation of Hospice Care survey results, which provide information related to perceived quality of care in multiple domains. Despite the tremendous growth that has occurred in the use of hospice care, there have been few studies of the actual services delivered to patients, including the mix of providers involved and the intensity of services over the course of the hospice episode. The ways in which the package of services received varies among patients with differing hospice diagnoses, or who live in their homes vs. nursing homes, are not well described. Further, there is a population of nursing home patients with palliative care needs who do not meet hospice eligibility criteria. Outside palliative care consultation is available in some markets but has only been anecdotally described. The specific aims of the project, outlined below, are designed to fill these gaps: 1) Provide a modern description of the specific hospice services received by nursing home patients, including the overall number and duration of visits by individual hospice professionals and volunteers; 2) Compare the volume of services received by hospice patients living in a nursing home versus those at home and correlate services with patient outcomes; and 3) Examine the characteristics of nursing home patients who received non-hospice palliative care consults and the content of recommendations provided by consultants, including eventual referral to hospice. In summary, the Beeson Career Development Award will provide critical support for me in my transition to independent investigator, as I build expertise through practical experiences and mentorship in nursing home care, palliative care, and hospice, as well as strengthen my foundation in key research skills through a rigorous program of formal coursework. In addition to the analyses possible through access to this clinical database, partnership with a large, national hospice provider will support future patient-oriented original data collection.

描述（由申请人提供）：此申请提出一个5年的职业发展和研究计划，以支持候选人获得成为以患者为导向的老龄化研究的独立研究者所需的知识和研究技能。由候选人和她的导师设计的职业发展计划是量身定制的，以承认在养老院环境中建立研究职业所需的特殊技能、经验和关系。培训计划包括通过印第安纳大学临床调查和转化教育（CITE）项目获得临床研究硕士学位的正式课程，以及在姑息治疗和养老院实践方面获得额外专业知识的校外培训活动。拟议的研究项目“为养老院患者提供临终关怀和姑息治疗服务”将与大型多州临终关怀和姑息治疗提供商Seasons Hospice合作进行。我们有超过50,000名安宁疗护病人的详细疗护记录，从2006年至2012年登记，以及约1,000名非安宁疗护缓和疗护咨询病人。在此资料库中，安宁疗护病患与缓和疗护谘询病患均有近1/3住在疗养院。安宁疗护记录与安宁疗护家庭评估调查结果相连结，该调查结果提供了与多个领域的感知疗护品质相关的资讯。尽管安宁疗护的使用出现了巨大的增长，但对提供给病人的实际服务的研究却很少，包括在安宁疗护过程中所涉及的提供者的组合和服务的强度。在不同的临终关怀诊断的病人，或谁住在自己的家与疗养院，所接受的一揽子服务的方式不同，没有很好地描述。此外，还有一群需要缓和疗护的疗养院病人，他们不符合安宁疗护的资格标准。外部姑息治疗咨询可在一些市场，但只是轶事描述。该项目的具体目标，概述如下，旨在填补这些空白：1)提供疗养院病人接受的具体安宁疗护服务的现代描述，包括个别安宁疗护专业人员和志愿者的总体次数和访问时间；2)比较住在疗养院的安宁疗护病人与住在家中的安宁疗护病人所接受的服务数量，并将服务与病人的治疗结果相关联；3)检视接受非安宁疗护的安宁疗护谘询的疗养院病人的特征，以及谘询者提供的建议内容，包括最终转介至安宁疗护。总而言之，比森职业发展奖将为我过渡到独立研究者提供关键的支持，因为我通过实践建立专业知识