Tube-feeding in Elderly: Decision-making and Outcomes

描述（由申请人提供）：拟定开发的目标 程序是准备申请人，苏珊L。米切尔医学博士的职业生涯作为一个 老龄化领域的独立调查员和领导者。 该奖项将 提供五年的监督老年医学健康服务研究， 具体目标：1。发展创新的专业知识， 老年人临终时的决策方法，2.到 成为成果研究和资源利用方面的专家， 在疗养院的体弱病人中使用医疗技术; 3.利用 这种在决策、健康结果和资源利用方面的专业知识 改善老年人的临终关怀， 管理和保健政策。 候选人将实现这些目标 通过指导研究，课程，指导阅读和教育 活动 刘易斯博士Lipsitz是老年医学的国际领导者， 哈佛医学院医学教授， 贝斯以色列女执事医疗中心（BIDMC）和希伯来语联合主任 老年康复中心（HRCA）研究和培训机构将 作为赞助商。 Lipsitz医生将确保Mitchell医生 HRCA丰富的环境优势，一个知名的中心，致力于 老年护理和研究，以及哈佛老龄化部门， BIDMC和哈佛公共卫生学院。 拟议的研究是一项随机试验的饲管决策援助， 患有晚期痴呆症的疗养院居民，随访一年， 临床结果和成本。 该项目的具体目标是 确定：1.决策辅助（与常规护理相比）是否能改善 长期管饲的决策过程，2.的冲击 关于替代决策者对管饲偏好的决策辅助， 3.长期管饲（与无管饲）对临床的影响 护理之家居民的结果和资源利用 痴呆 除了拟议的项目，米切尔博士将实现她的职业生涯 定期与Lipsitz博士以及 她的顾问小组包括：1。A. O康纳和A.穆利- 卫生政策，2。布坎南博士-经济评估，3。 M博士Gillick - bioethics，4. J.温伯格ScD -高级统计方法 和5. M博士奴隶的临终关怀她的研究活动将是 辅以集中的临床、教育和行政活动 包括担任哈佛老年医学奖学金的副主任 程序. 在奖励期结束时，申请人将具备以下技能、经验 以及成为独立调查员所需的研究跟踪记录， 老年医学领域的领军人物

DESCRIPTION (provided by applicant): The goal of the proposed development program is to prepare the applicant, Susan L. Mitchell MD for a career as an independent investigator and leader in the field of aging. The award will provide five years of supervised geriatrics health services research with the following specific objectives: 1. to develop expertise in innovative approaches to decision-making for older persons at the end-of-life, 2. to become an expert in outcomes research and resource utilization related to the use medical technologies in frail nursing home patients, and 3. to utilize this expertise in decision-making, health outcomes, and resource utilization to improve the end-of-life care in older persons by influencing clinical management and health care policy. The candidate will achieve these goals through mentored research, coursework, directed readings and educational activities. Dr. Lewis A. Lipsitz, an international leader in geriatrics, Professor of Medicine at Harvard Medical School, Chief of Geriatrics at the Beth Israel Deaconess Medical Center (BIDMC) and Co-Director of the Hebrew Rehabilitation Center for Aged (HRCA) Research and Training Institute will serve as sponsor. Dr. Lipsitz will ensure that Dr. Mitchell will have full advantage of the rich environment of the HRCA, a reknowned center dedicated to gerontological care and research, as well as the Harvard Division on Aging, BIDMC and Harvard School of Public Health. The proposed research is a randomized trial of a feeding tube decision aid for nursing home residents with advanced dementia with a one year follow-up of clinical outcomes and costs. The specific aims of the project are to determine: 1. whether a decision-aid (vs. usual care) improves the decision-making process for long-term tube-feeding, 2. the impact of a decision aid on the substitute decision-makers preferences for tube-feeding, 3. the impact of long-term tube-feeding (vs. no tube-feeding) on clinical outcomes and resource utilization in nursing home residents with advanced dementia. In addition to the proposed project, Dr. Mitchell will achieve her career goals by regularly scheduled meeting with Dr. Lipsitz, as well as members of her advisory panel including; 1. Drs. A. O Connor and A. Mulley - decision-making, health policy, 2. Dr. J. Buchanan - economic evaluation, 3. Dr. M. Gillick - bioethics, 4. J. Weinberg ScD - advanced statitstical methods and 5. Dr. M. Slaven - end-of-life care. Her research activities will be complimented by focussed clinical, educational and administrative activities including the associate directorship of the Harvard Geriatrics Fellowship Program. By the end of the award period the applicant will have the skills, experience and research track record necessary to become an independent investigator and leader in academic geriatrics.