Understanding Inappropriate Treatment in Critically Ill Older Patients

 简介(由申请人提供)：Thanh neille博士是加州大学洛杉矶分校肺和重症监护科的初级教员，他的长期目标是利用研究来提高重症监护病房(ICU)的护理质量和适宜性。她的职业目标是成为一名独立调查员，并成为老龄和重症护理研究的学术领先者。她目前的导师尼尔·温格博士是一位著名的卫生服务研究员，也是加州大学洛杉矶分校伦理中心的主任。她还拥有一支由合格的合作导师和顾问组成的多学科团队，他们每人将在定性分析、统计建模、老龄化研究以及干预措施的制定和实施方面提供指导。加州大学洛杉矶分校的定性方法、老化、实施科学和生物统计学方面的正式课程将补充她从导师那里得到的指导。她得到了她所在部门的大力支持，并将在加州大学洛杉矶分校进行研究，这是一所以学术、临床和研究卓越而闻名的机构。在这份提案中，内维尔博士试图描述与老年患者在ICU接受不适当治疗有关的因素，以及如何改变医生的行为和整个系统的做法，将这种治疗转变为适当的姑息治疗。老年患者是ICU中需要护理的最大亚群体，而且容易受到治疗与预后不匹配的有害影响。不适当的治疗，这里的定义是不应该提供的治疗，因为它不能为患者提供好处，可能会延长痛苦，导致家庭痛苦，并将死亡转变为有损尊严的过程。这个项目建立在内维尔博士定义和量化ICU中不适当治疗的工作基础上。它探索和分析了她收集的关于接受不适当治疗的患者、可能接受不适当治疗的患者以及没有在ICU接受不适当治疗的患者的先前完成的病历摘要。拟议项目的目标是1)使用定性和定量的方法来探索与为老年危重患者提供不适当的ICU治疗相关的患者、医生、沟通和结构因素；2)开发和验证一个预期的工具来识别进入ICU的RSK患者的不适当治疗；以及3)开发和试点干预措施，以减少在ICU中的不适当治疗。这项应用将是朝着开发干预措施的方向迈出的一步，在预后不佳的情况下，这些干预措施可以成功地重新定位危重护理。

 DESCRIPTION (provided by applicant): Dr. Thanh Neville is a junior faculty member in the Division of Pulmonary and Critical Care at UCLA who has the long-term goal of using research to improve the quality and appropriateness of care in the intensive care unit (ICU). Her career objective is to become an independent investigator and an academic leader in aging and critical care research. She is currently mentored by Dr. Neil Wenger, who is a well-known health services researcher and the Director of the UCLA Ethics Center. She also has a multi-disciplinary team of well-qualified co-mentors and advisors who will each provide direction in qualitative analysis, statistical modeling, aging research, and intervention development and implementation. Formal courses at UCLA in qualitative methods, aging, implementation science, and biostatistics will complement the guidance she receives from her mentors. She is strongly supported by her division and will be performing her research at UCLA, an institution renowned for its academic, clinical, and research excellence. In this proposal, Dr. Neville seeks to characterize the factors related to older patients receiving inappropriate treatment in the ICU and how physician behavior and system-wide practices might be changed to transition such treatment toward appropriate palliative care. Older patients are the largest growing subset of patients requiring care in the ICU and are vulnerable to the harmful effects of the mismatch of treatment to prognosis. Inappropriate treatment, defined here as a treatment that should not be provided because it does not offer the patient benefit, can prolong suffering, cause family distress, and transform death into an undignified process. This project builds on Dr. Neville's work in defining and quantitating inappropriate treatment in the ICU. It explores and analyzes a previously completed medical record abstraction that she has collected on patients who received inappropriate treatment, patients who received probably inappropriate treatment, and patients who did not receive inappropriate treatment in the ICU. The goal of the proposed project is to 1) use qualitative and quantitative methods to explore the patient, physician, communication, and structural factors related to provision of inappropriate ICU treatment for older critically ill patients, 2) develop and validate a prospective tool to identify patients at rsk of inappropriate treatment at entry into the ICU, and 3) develop and pilot an intervention to decrease inappropriate treatment in the ICU. This application will be a step toward developing interventions that successfully reorient critical care when the prognosis is poor.