Delivering Hospice and Palliative Care Services to Nursing Home Patients

描述（由申请人提供）：本申请提出了一个5年的职业发展和研究计划，以支持候选人的知识和研究技能的收购需要成为一个独立的研究人员在病人为导向的老龄化研究。由候选人和她的导师设计的职业发展计划是量身定制的，以承认特殊的技能，经验和关系，需要建立一个研究职业生涯集中在养老院设置。培训计划包括正式的课程，以获得硕士学位的临床研究通过印第安纳州大学临床调查和转化教育（CITE）计划，以及校外培训活动，以获得更多的专业知识，在姑息治疗和疗养院的做法。 拟议的研究项目，“提供临终关怀和姑息治疗服务，以护理之家的病人，”将进行合作，与一个大型的多州临终关怀和姑息治疗提供者，季节临终关怀。我们可以查阅2006年至2012年登记的50，000多名临终关怀患者的详细患者护理记录，以及约1，000名非临终关怀姑息治疗咨询患者的详细记录。近1/3的临终关怀病人和姑息治疗咨询病人在这个数据库中生活在疗养院。临终关怀记录与临终关怀家庭评价调查结果相关联，该调查结果提供了与多个领域的感知护理质量相关的信息。尽管在临终关怀的使用已经发生了巨大的增长，有一些研究提供给病人的实际服务，包括混合的提供者参与和服务的强度在整个临终关怀事件。在不同临终关怀诊断的病人之间，或者住在家里的病人与住在疗养院的病人之间，接受一揽子服务的方式各不相同，这一点没有得到很好的描述。此外，有一个人口的疗养院病人姑息治疗的需要谁不符合临终关怀的资格标准。一些市场提供外部姑息治疗咨询，但只是零星描述。该项目的具体目标，概述如下，旨在填补这些空白：1）提供一个现代的描述具体临终关怀服务的护理之家的病人，包括总人数和持续时间的访问个别临终关怀专业人员和志愿者;（二）比较居住在疗养院的临终关怀患者与居住在家中的临终关怀患者接受的服务量，成果;及3）检视接受非安宁缓和疗护谘询的护理之家病人的特徴，以及顾问提供的建议内容，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调查员提供关键支持，因为我通过实践积累了专业知识。 在疗养院护理，姑息治疗和临终关怀的经验和指导，以及通过正式课程的严格计划加强我的关键研究技能的基础。除了通过访问该临床数据库可能进行的分析外，与大型国家临终关怀提供商的合作伙伴关系将支持未来以患者为导向的原始数据收集。

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.