Research Project 3

摘要-研究项目3 标题：针对需求的干预措施对未满足需求的种族差异的影响 重症监护室的病人和家属 姑息治疗的质量是高度可变的近500万每年ICU入院。 许多病人和家属报告说，他们的需求得不到满足，沟通和决策能力差; 然而，这些报告在非洲裔美国人及其家庭中更为常见， 对ICU护理质量不满意。大范围提高ICU护理质量是 具有挑战性，因为有限的姑息治疗工作人员和ICU临床医生的困难， 主动识别和解决不同患者和家庭中未满足的需求 成员为了应对这些挑战，我们开发了一个移动的应用程序， 患者和家属自我报告需求，获得有关姑息治疗的信息， 可以提高理解的问题的例子。临床医生可以可视化患者/家属 需要和如何解决这些问题的决策支持。在一系列的试点研究中，我们发现 需求应用程序是可接受的，可行的，可以减少未满足的姑息治疗需求， 种族/民族多样化的人口。 虽然我们的试点数据是有希望的，但我们需要明确确定 干预及其对护理中种族差异的影响。建议的研究将：（1）优化 应用平台在种族多样化人群中的可用性，（2）测试应用增强的影响 减少种族差异的阶梯楔形试验中的护理与常规护理（非裔美国人 和白人）在未满足的需求和满意度的照顾;和（3）探索病人，家庭成员， 和临床医生的经验，使用混合的方法来了解干预机制， 独特的案例背景。我们假设，与常规护理相比， 护理将减少家庭成员未得到满足的需求和心理困扰， 患者接受目标一致治疗的频率，并缩短住院时间， 包括白人和非裔美国人

Abstract - Research Project 3 TITLE: The effect of a needs-targeted intervention on racial disparities in unmet needs of patients and families in the intensive care unit The quality of palliative care is highly variable for the nearly 5 million annual ICU admissions. Many patients and families report unmet needs and poor communication and decision making; however, these reports are more common among African Americans and their families who are less satisfied with the quality of ICU care. Improving ICU care quality on a broad scale is challenging because of a limited palliative care workforce and ICU clinicians' difficulties in proactively identifying and addressing unmet needs among diverse patients and family members. To address these challenges to care delivery, we developed a mobile app that allows patients and families to self-report needs, receive information about palliative care, and get examples of questions that can improve understanding. Clinicians can visualize patient/family needs and decisional support on how to address them. In a series of pilot studies, we found that the need app is acceptable, feasible, and can reduce unmet palliative care needs in race/ethnically diverse populations. While our pilot data are promising, we need to definitively determine the effectiveness of the intervention and its effect on racial disparities in care. The proposed study will: (1) Optimize the app platform's usability in a racially diverse population, (2) Test the impact of app-augmented care vs usual care in a stepped-wedge trial on reducing racial disparities (African Americans and Whites) in unmet needs and satisfaction with care; and (3) Explore patient, family member, and clinician experiences using mixed methods to understand intervention mechanisms within unique case contexts. We hypothesize that compared to usual care, needs app-augmented care will reduce family members' unmet needs and psychological distress, increase the frequency of patients' receipt of goal concordant treatment, and reduce hospital length of stay in both whites and African Americans.