Medical-Surgical Co-management Evaluating a New Award

在过去的十年里，对住院患者的护理发生了显著的变化。外科手术和医疗服务的转变 门诊医疗服务和降低成本的压力增加了患者的敏锐度 住院患者以及提高临床效率和护理质量的需要。部分原因是 在这些压力下，许多医院重新设计了他们的住院服务，以便专门的住院专科医生(住院医生)为内科患者提供住院护理。此外，住院医生还在许多地点直接护理非医疗(即外科)服务的患者。这一新角色的发展被称为“共同管理”，与住院医生模式的发展是平行的，但其影响尚不清楚。加州大学旧金山分校实施共同管理将允许对共同管理进行第一次严格的评估，并为这一培训奖项提供实验室。 拟议的课程将增强首席调查员在以下方面的现有技能 结果研究、成本效益分析和临床流行病学，在执行临床试验、分析复杂数据集以及与执行和评估医疗保健系统中的变化相关的组织理论时，方法论非常有用。 该提案还描述了三个研究目标，将分两个阶段实现。第一阶段将 涉及医疗并发症风险指数的推导，以识别高危患者。第二阶段将围绕指数确定的高危患者管理的随机试验，并将检查管理对患者安全(以医疗并发症发生率衡量)、利用率和患者满意度的影响。第三个目标也将在第二阶段进行，涉及完善数据收集战略，以便在未来的多中心研究中使用。 因此，该奖项将允许申请者发展对其临床和研究生涯重要的新技能，并为他成为围手术期医学成果研究和提高围手术期患者安全性的组织方法的独立调查员提供环境。

The care of hospitalized patients has evolved markedly in the last decade. Shifts in surgical and medical care to outpatient settings and pressure to reduce costs have increased the acuity of hospitalized patients and the need for improved clinical efficiency and care quality. In part due to these pressures, many hospitals have redesigned their inpatient services so that dedicated inpatient specialists ('hospitalists') provide inpatient care to medical patients. In addition, hospitalists also direct care of patients on non-medical (i.e. surgical) services at many sites. Growth of this new role, termed 'comanagement,' is paralleling that of the hospitalist model, yet its effects are unknown. Implementation of comanagement at UCSF will permit the first rigorous evaluation of comanagement and provide a laboratory for this training award. The proposed course of study will augment the Principal Investigator's (PI) existing skills in outcomes research, cost-effectiveness analysis, and clinical epidemiology with methodology useful in the execution of clinical trials, analysis of complex datasets, and organizational theory as it relates to executing and assessing changes in healthcare systems. This proposal also describes 3 research goals, to be achieved in 2 phases. The first phase will involve derivation of a medical complication risk index to identify high-risk patients. Phase 2 will be centered around a randomized trial of comanagement of at-risk patients identified by the index, and will examine comanagement's impact on patient safety (as measured by medical complication rates), utilization, and patient satisfaction. The third goal, to also take place in Phase 2, involves refinement of data collection strategies for use in future multicenter studies. Thus, this award will allow the applicant to develop new skills important to his clinical and research career, and provide the setting in which he will become an independent investigator in perioperative medicine outcomes research and organizational methods to improve perioperative patient safety.