Dizziness in the Emergency Department: A Population-Based Project

描述(由申请人提供)：头晕是门诊护理环境中最常见的主要症状之一。最近的进展显著提高了诊断和治疗头晕常见原因的能力，但这种信息可能没有充分传播给一线医生或培训主任，因为头晕专家并不常见。因此，缺陷和低效很可能普遍存在，也许无处不在，但还没有大规模的基于人口的研究集中于评估这一重要问题。通常，当良性的外周前庭出现时，患者会接受广泛的评估，寻找中枢神经系统的病因 疾病得不到治疗，或者相反，当早期的严重疾病是原因时，就被认为是良性疾病。因此，头晕患者的疾病负担和医疗保健利用率可能会不必要地高，但这些重要的衡量标准也没有在基于人群的研究中确定。这些因素对于确定NIH已宣布为优先事项的疾病的影响至关重要。急诊科(ED)是集中最初努力的适当场所，因为头晕在急诊室很常见，迫切需要努力改善急诊室的过度拥挤。利用一项由NIH资助的基于人群的研究中确定的患者，我们假设这些患者的疾病负担和医疗保健利用率很高。在未来的R01应用中，解决这项研究的重要发现可能会提高护理质量，减少医疗费用，并减少急诊室过度拥挤。基本项目在招募大量受试者方面取得了成功，并涉及到与社区和当地公共卫生部门的长期合作。该候选人是一名神经科医生，受过神经耳科的训练，致力于以病人为中心的研究事业。这项申请提出了一个5年计划，包括通过密歇根大学K30 NIH临床研究培训计划进行正式培训，将候选人培养成独立的临床研究人员。这个K30课程包括核心课程、个性化的科学咨询委员会，以及关于重点研究领域的小组研讨会。一所顶尖公立大学的一流资源，以及在培养专注于本项目和未来项目关键要素的职业生涯方面取得成功的导师，使密歇根大学成为理想的大学 候选人所处的环境。相关性：识别护理中的缺陷对于提高护理质量、减少医疗支出和减少急诊室过度拥挤至关重要。

DESCRIPTION (provided by applicant): Dizziness is among the most common principal complaints in the ambulatory care setting. Recent advances significantly improve the ability to diagnose and treat common causes of dizziness but this information may not be adequately disseminated to frontline physicians or training directors because specialists in dizziness are not common. As a result, deficiencies and inefficiencies are likely to be prevalent, perhaps ubiquitous, but no large population-based study has focused on evaluating this important issue. Often patients undergo extensive evaluations searching for central nervous system etiologies while a benign peripheral vestibular disorder goes untreated, or conversely a benign disorder is assumed when an early severe disorder is the cause. Therefore, burden of illness and healthcare utilization may be unnecessarily high in patients with dizziness, but these important measures also have not been determined in population-based studies. These factors are critical in determining the impact of an illness which the NIH has declared a priority. The emergency department (ED) is an appropriate setting to focus initial efforts because dizziness is common in the ED and efforts to improve ED overcrowding are desperately needed. Utilizing patients identified in an established, NIH funded, population-based study, the Brain Attack Surveillance In Corpus Christi (BASIC) project, we hypothesize that .0ed and that burden of illness and healthcare utilization are high among these patients. In a future R01 application, addressing the important findings of this study may improve quality of care, decrease healthcare expenditures, and decrease ED overcrowding. The BASIC project has demonstrated success in recruiting large numbers of subjects and involves long-term collaboration with the community and local Public Health Department. The candidate is a neurologist fellowship trained in neuro-otology, dedicated to a career in patient- oriented research. This application proposes a 5-year plan, including formal training through the K30 NIH Clinical Research Training program at the University of Michigan, to develop the candidate into an independent clinical researcher. This K30 program includes a core curriculum, individualized scientific advisory committee, and small group seminars on focused areas of research. Superb resources of a top public university and mentors with demonstrated success in fostering careers focused on key elements of this and future projects makes the University of Michigan an ideal environment for the candidate. Relevance: Identifying deficiencies in care is critical to improving quality of care, reducing healthcare expenditures, and decreasing ED overcrowding.