Research Project 3

摘要-研究项目3 标题：以需求为目标的干预对未得到满足的需求中的种族差异的影响 重症监护病房中的病人和家属 对于每年近500万的ICU入院患者来说，姑息治疗的质量是高度不同的。 许多患者和家属报告说，需求未得到满足，沟通和决策能力差； 然而，这些报告在非洲裔美国人及其家人中更为常见 对ICU护理质量不太满意。全面提高ICU护理质量是 具有挑战性，因为姑息治疗劳动力有限，ICU临床医生在 主动识别和解决不同患者和家庭中未得到满足的需求 会员。为了应对这些护理交付方面的挑战，我们开发了一款移动应用程序，可以 患者和家属自我报告需求，接受关于姑息治疗的信息，并获得 可以提高理解的问题的例子。临床医生可以将患者/家人视觉化 关于如何解决这些问题的需求和决策支持。在一系列先导研究中，我们发现 Need应用程序是可接受的、可行的，并且可以减少未得到满足的姑息治疗需求 种族/民族多样化的人口。 虽然我们的试点数据很有希望，但我们需要最终确定 干预措施及其对保健方面的种族差异的影响。建议的研究将：(1)优化 应用程序平台在不同种族人群中的可用性，(2)测试应用程序增强的影响 在一项关于减少种族差异的阶梯式楔形试验中，护理与常规护理的对比(非裔美国人 和白人)未得到满足的需求和对护理的满意度；以及(3)探索患者、家庭成员、 和临床医生使用混合方法了解介入机制的经验 独特的案例上下文。我们假设，与通常的护理相比，需要应用程序增强 关爱将减少家庭成员未得到满足的需求和心理痛苦，增加 患者接受目标协调治疗的频率，减少住院天数 无论是白人还是非裔美国人。

Abstract - Research Project 3 TITLE: The effect of a needs-targeted intervention on racial disparities in unmet needs of patients and families in the intensive care unit The quality of palliative care is highly variable for the nearly 5 million annual ICU admissions. Many patients and families report unmet needs and poor communication and decision making; however, these reports are more common among African Americans and their families who are less satisfied with the quality of ICU care. Improving ICU care quality on a broad scale is challenging because of a limited palliative care workforce and ICU clinicians' difficulties in proactively identifying and addressing unmet needs among diverse patients and family members. To address these challenges to care delivery, we developed a mobile app that allows patients and families to self-report needs, receive information about palliative care, and get examples of questions that can improve understanding. Clinicians can visualize patient/family needs and decisional support on how to address them. In a series of pilot studies, we found that the need app is acceptable, feasible, and can reduce unmet palliative care needs in race/ethnically diverse populations. While our pilot data are promising, we need to definitively determine the effectiveness of the intervention and its effect on racial disparities in care. The proposed study will: (1) Optimize the app platform's usability in a racially diverse population, (2) Test the impact of app-augmented care vs usual care in a stepped-wedge trial on reducing racial disparities (African Americans and Whites) in unmet needs and satisfaction with care; and (3) Explore patient, family member, and clinician experiences using mixed methods to understand intervention mechanisms within unique case contexts. We hypothesize that compared to usual care, needs app-augmented care will reduce family members' unmet needs and psychological distress, increase the frequency of patients' receipt of goal concordant treatment, and reduce hospital length of stay in both whites and African Americans.