Which palliative care quality measures improve patient-centered outcomes?

 描述（由申请人提供）：我的职业目标是作为一个独立的健康服务研究人员成熟，重点是质量和姑息治疗，以改善严重和慢性疾病患者及其护理人员的经验。姑息治疗是一种较新的临床 该学科专注于改善所有患者的生活质量，与预后无关。姑息治疗取得了显著的增长，66%的医院提供临床服务。尽管如此，标准化的临床方法还不存在。这种方法需要评估哪些护理过程，建议公布的质量措施，提高以病人为中心的结果最。然后，可以优先考虑具有最大影响的护理流程和相关质量措施。我们已经建立了进行这项调查的基础设施。具体来说，我领导了QDACT-PC（质量数据收集工具姑息治疗）的开发，这是一个基于iPad（tm）的即时数据收集系统，可以同时填充护理流程，质量措施依从性以及患者和卫生系统结果的注册表。2013年9月，我们获得了AHRQ R18赠款，在姑息治疗研究合作组（PCRC）中在全国范围内实施QDACT-PC，这是姑息治疗的第一个国家研究合作。我的导师和该提案的PI Amy Abernethy博士为K 08申请保留了分析目标。我的研究目标是使用这个快速增长的注册表，探讨质量措施的坚持对姑息治疗环境中的结果的影响。在导师的指导下，我将首先描述1000名患者中临床医生对20项核心姑息治疗质量指标的依从性变化。然后，我将使用定量和定性的方法来确定一组姑息治疗质量指标和患者报告的结果，包括护理满意度，生活质量和症状缓解之间的关系。最后，我将调查坚持一套质量措施和卫生服务利用率之间的关系，衡量30天的再入院率，住院时间，和整体医疗保健费用。总之，这些目标以及一个强大的职业发展计划和专门的指导，将准备我的R 01级提交前瞻性测试确定的核心集以患者为中心的结果。

 DESCRIPTION (provided by applicant): My career goal is to mature as an independent health services researcher, with a focus on quality and palliative care, to improve the experience of patients with serious and chronic illness and their caregivers. Palliative care is a newer clinical discipline focused on improving quality of life for all patients, independent of prognosis. Palliative care has achieved remarkable growth, with clinical services present in 66% of all hospitals. Despite such growth, a standardized clinical approach does not yet exist. Such an approach requires evaluating which care processes, recommended by published quality measures, improve patient-centered outcomes the most. Then, the care processes and associated quality measures with the greatest impact can be prioritized. We have developed the infrastructure to perform this investigation. Specifically, I led the development of QDACT-PC (Quality Data Collection Tool Palliative Care), a point-of-care, iPad(tm)-based data collection system that simultaneously populates a registry of care processes, quality measure adherence, and patient and health system outcomes. In September 2013, we were awarded an AHRQ R18 grant to implement QDACT-PC nationally in the Palliative Care Research Cooperative Group (PCRC), the first national research collaborative for palliative care. Analysis aims were reserved by my mentor and the PI of that proposal, Dr. Amy Abernethy, for this K08 application. My research goal is to use this quickly growing registry to explore the impact of quality measure adherence on outcomes in the palliative care setting. Under the guidance of my mentors, I will first, I will describe variability in clinician adherence to a set of 20 core palliative care qualiy measures among 1000 patients. Then, I will use quantitative and qualitative methods to determine the relationship between adherence to a set of palliative care quality measures and patient-reported outcomes, including satisfaction with care, quality of life, and symptom relief. Last, I will investigate the relationship between adherence to a set of quality measures and health service utilization, as measured by 30-day readmission rates, length of stay, and overall health care costs. Together, these aims alongside a robust career development plan and dedicated mentorship, will prepare me for an R01-level submission prospectively testing the identified core set on patient-centered outcomes.