Understanding Variation in the Use of Critical Care Services

描述(申请人提供)：这一K08奖项将为候选人科林·R·库克博士提供一个机会，让他成为一名独立的内科科学家，专注于提高重症监护的组织、交付和融资方面的价值和效率。在过去的20年里，危重病护理服务的使用在美国迅速增长，同时它目前的使用在不同的地理区域也有很大的差异。到目前为止，人们对这种增长和变化的潜在驱动因素和影响知之甚少。这份科学家发展申请描述了库克博士的全面计划，以实现以下主要目标：1)更好地确定重症监护应用增长和变异的原因和影响，以及2)发展独立的卫生服务研究事业。为了实现这些目标，库克博士提出了一个综合课程，包括设计、实施和发表与政策相关的卫生服务研究项目的实践经验；为补充他之前在流行病学和生物统计学方面的研究培训而设计的课程，包括高级生物统计学、卫生融资和政策以及计量经济学；由卫生保健效率、危重护理政策和卫生经济学方面的专家进行密集指导；以及参加国家科学会议。密歇根大学丰富的学术环境非常适合库克博士的培训，并使他能够组建一个导师委员会，其成员拥有重症护理质量、卫生政策、经济学和生物统计学方面的专业知识。库克博士将分析6年来按服务收费的联邦医疗保险患者，以：1)确定患者类型以及医疗系统和政策层面的因素，这些因素是重症监护利用率的时间和地理差异的基础，2)确定地区重症监护实践模式对死亡率、再次住院和成本的影响。最后，r.库克将检查全州范围内的手术质量协作，以确定危重护理实践模式如何影响手术后临床结果。拟议研究的完成将为旨在提高住院设施中危重病人护理效率的政策提供信息，并为整个保健系统协调危重病人的护理工作提供参考。此外，该项目将促进候选人向独立的保健服务调查员过渡，重点是了解和提高危重护理的效率。

DESCRIPTION (provided by applicant): This K08 award will provide an opportunity for the candidate, Dr. Colin R. Cooke, to become an independent physician scientist focused on increasing the value and efficiency in the organization, delivery, and financing of critical care. Over the last 20 years the use of critical care services has grown rapidly in the United States, while at the same its current use varies widely across geographic regions. To date, very little is known about the underlying drivers and implications of such growth and variation. This scientist development application describes Dr. Cooke's comprehensive plan to accomplish the following primary goals: 1) to better identify the causes and implications of growth and variation critical care utilization, and 2) to develop an independent health services research career. To achieve these goals, Dr. Cooke proposes an integrated curriculum consisting of practical experience in designing, conducting and publishing policy-relevant health services research projects; coursework designed to supplement his previous research training in epidemiology and biostatistics consisting of advanced biostatistics, health financing and policy, and econometrics; intensive mentoring by experts in health care efficiency, critical care policy, and health economics; and participating in national scientific meetings. The rich academic environment at the University of Michigan is ideal for Dr. Cooke's training and has allowed him to assemble a mentorship committee whose members possess expertise in critical care quality, health policy, economics, and biostatistics. Dr. Cooke will analyze fee-for-service Medicare patients over 6 years to: 1) identify the types of patients and the health system and policy- level factors that underlie temporal and geographic variation in critical care utilization, and 2) determine the effec of regional critical care practice patterns on mortality, re-hospitalizations, and costs. Finally, r. Cooke will examine a statewide surgical quality collaborative to determine how critical care practice patterns impact post-operative clinical outcomes. Completion of the proposed research will inform policies aimed at improving the efficiency of critical care in inpatient facilities andthe coordination of care for critically ill patients across the health system. In addition this projectwill facilitate the candidate's transition to an independent health services investigator focused on understanding and improving the efficiency of critical care.