Medical-Surgical Co-management Evaluating a New Award

在过去的十年里，住院病人的护理有了显著的发展。手术和 医疗保健门诊设置和压力，以减少成本增加了敏锐的， 住院病人和需要提高临床效率和护理质量。部分原因是 由于这些压力，许多医院重新设计了住院服务，以便专门的住院专家（“住院医师”）为内科病人提供住院护理。此外，住院医师还在许多地点指导病人的非医疗（即外科）服务。这种新角色的发展，被称为“科曼蒂克”，与住院医生模式的发展是平行的，但其影响尚不清楚。在加州大学旧金山分校实施的comankraft将允许comankraft的第一次严格的评估，并提供了一个实验室，这个培训奖。 拟议的研究课程将增强主要研究者（PI）的现有技能， 结果研究，成本效益分析和临床流行病学与方法学在临床试验的执行，复杂数据集的分析和组织理论，因为它涉及到执行和评估医疗保健系统的变化有用。 该提案还描述了3个研究目标，分2个阶段实现。第一阶段将 包括导出医疗并发症风险指数以识别高风险患者。第二阶段将围绕一项随机试验，对指数确定的高风险患者进行comanadine，并将检查comanadine对患者安全性（以医疗并发症率衡量）、利用率和患者满意度的影响。第三个目标也将在II期进行，涉及改进数据收集策略，以用于未来的多中心研究。 因此，该奖项将使申请人能够发展对他的临床和研究生涯至关重要的新技能，并提供环境，使他成为围手术期医学成果研究和组织方法的独立研究者，以提高围手术期患者的安全性。

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.