Improving Clinical Decisions for Critically Ill Traumatic Brain Injury Patients

改善危重脑外伤患者的临床决策

• 批准号: 8967750
• 负责人: Susanne Muehlschlegel
• 金额: $ 13.23万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-26 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8967750
• 关键词: Accounting; Address; Admission activity; Benefits and Risks; Brain Injuries; Caring; Cause of Death; Cessation of life; Clinical; Cohort Studies; Coma; Communication; Comprehension; Conflict (Psychology); Critical Care; Critical Illness; Data; Decision Aid; Decision Making; Derivation procedure; Development; Development Plans; Disease; Ensure; Equilibrium; Face; Family; Family Physicians; Focus Groups; Goals; Grant; Group Structure; Health; Healthcare; Healthy People 2020; Hospitals; Institute of Medicine (U.S.); Institution; Intensive Care Units; International; Intervention; Interview; Knowledge; Language; Lead; Learning; Life; Massachusetts; Medical; Mentors; Mentorship; Methods; Neurologic; Neurologist; New England; Outcome; Outcomes Research; Patient Preferences; Patient risk; Patients; Physicians; Positioning Attribute; Prevention; Process; Prospective Studies; Proxy; Psychosocial Factor; Qualitative Methods; Quality of life; Randomized Controlled Trials; Regression Analysis; Regrets; Research; Research Personnel; Research Proposals; Risk; Risk Factors; Science; Scientist; Severity of illness; Structure; Testing; Training; Trauma; Traumatic Brain Injury; Uncertainty; Universities; Withdrawal; base; career; career development; clinical decision-making; cohort; design; didactic education; disability; evidence base; expectation; functional outcomes; health literacy; high risk; improved; mathematical ability; medical schools; meetings; modifiable risk; mortality; outcome forecast; patient oriented; patient oriented research; pilot trial; preference; prototype; psychosocial; public health relevance; shared decision making; skills; tool; trauma centers; treatment strategy

 DESCRIPTION (provided by applicant): Dr. Susanne Muehlschlegel is a Critical Care Neurologist at the University of Massachusetts Medical School (UMMS) whose goal is to become an independent investigator with expertise in patient outcome prediction, shared decision making, and decision-science to improve clinical decision making for patients with catastrophic brain injuries and their families. Moderate to severe traumatic brain injury (msTBI) remains the leading cause of death after trauma which mostly follows withdrawal of care. Dr. Muehlschlegel will tackle the life-or-death decision about continuation or withdrawal of care ("goals-of-care") in msTBI patients and develop a decision aid for health care proxies of these critically ill patients. Dr. Muehlschlegel's career development plan brings together an outstanding team of investigators from three leading institutions, including the UMMS, University of New England, and University of Pittsburgh. Dr. Muehlschlegel has already obtained preliminary results in msTBI patients confirming that intensive care unit (ICU) complications are associated with worse short-term functional patient outcomes and mortality, and also lead to worse subjective prognostication by clinicians. Based on her daily interactions with families of msTBI patients in her unique clinical position as a neuroICU physician, Dr. Muehlschlegel is acutely aware of the need to improve prognostication and its communication between physicians and families while also including patient's values and preferences. Under the mentorship of Drs. Goldberg, Col, Shutter and Mazor, Dr. Muehlschlegel proposes to: (1a) identify key psychosocial factors of goals-of-care decisions in health care proxies of msTBI patients and physicians in focus groups and structured interviews; (1b) develop a new outcome prediction score for msTBI patients including ICU complications and previously validated admission predictors in a prospectively collected hospital-based cohort of patients with msTBI and to validate her findings internally; (2) create a decision aid prototype for goals-of- care decisions in msTBI patients by incorporating results from Aims 1a and 1b, and the well known and validated msTBI outcome prediction "IMPACT score" based on hospital admission variables; and (3) to pilot test the decision aid in a feasibility trial in the neuroICU. The overal goal of this proposal is to develop a goals- of-care decision aid that may improve health outcomes for msTBI patients by ensuring proxies receive evidence-based prognostication, understand projected outcomes and risks, while also addressing patient's preferences and values. This well-defined mentored patient-oriented research proposal will bring together cutting-edge qualitative and quantitative methods for decision aid and outcome prediction rule derivation, and a team with expertise in outcomes research, shared decision making, and neurocritical care of msTBI patients. This proposal, in concert with a structured didactic curriculum of advanced statistical, qualitative, and decision- science coursework, will provide Dr. Muehlschlegel with the skills and mentorship that are essential for her to develop an independent career in neuroICU research at the cutting edge of shared decision making science.

 描述（由申请人提供）：Susanne Muehlschlegel博士是马萨诸塞州医学院（UMMS）的重症监护神经学家，其目标是成为一名独立的研究者，在患者结局预测、共同决策和决策科学方面具有专业知识，以改善灾难性脑损伤患者及其家属的临床决策。中度至重度创伤性脑损伤（msTBI）仍然是创伤后死亡的主要原因，主要是在撤回护理后。Muehlschlegel博士将处理msTBI患者继续或停止护理（“护理目标”）的生死决定，并为这些危重患者的医疗保健代理开发决策辅助。Muehlschlegel博士的职业发展计划汇集了来自三个领先机构的优秀研究人员团队，包括UMMS，新英格兰大学和匹兹堡大学。Muehlschlegel博士已经在msTBI患者中获得了初步结果，证实重症监护室（ICU）并发症与患者短期功能结局和死亡率恶化相关，并且还导致临床医生的主观判断恶化。根据她作为神经ICU医生的独特临床地位与msTBI患者家属的日常互动，Muehlschlegel博士敏锐地意识到需要改善医生和家属之间的沟通，同时也包括患者的价值观和偏好。在Goldberg博士、Col博士、Shutter博士和Mazor博士的指导下，Muehlschlegel博士建议：（1a）在焦点小组和结构化访谈中，确定msTBI患者和医生的医疗保健代理中的护理目标决策的关键心理社会因素;（1b）为msTBI患者开发新的结果预测评分，包括ICU并发症和在前瞻性收集的医院中先前验证的入院预测因子，（2）通过合并目标1a和1b的结果以及基于入院变量的众所周知且经验证的msTBI结果预测“IMPACT评分”，为msTBI患者的护理目标决策创建决策辅助原型;以及（3）在神经ICU的可行性试验中对决策辅助进行初步测试。本提案的总体目标是开发一种护理目标决策辅助工具，通过确保代理人接受循证诊断、了解预计结局和风险，同时解决患者的偏好和价值观，可以改善msTBI患者的健康结局。这个定义明确的指导以患者为导向的研究提案将汇集决策辅助和结果预测规则推导的尖端定性和定量方法，以及具有结果研究，共享决策和msTBI患者神经重症监护专业知识的团队。这个建议，在与先进的统计，定性和决策科学课程的结构化教学课程的音乐会，将提供博士。 Muehlschlegel的技能和指导是必不可少的，她在共同决策科学的前沿发展神经ICU研究的独立职业生涯。