Causes and Effects of Hospital-Level Changes in ICU Bed Supply

在过去的30年里，美国见证了危重病护理提供系统的转变 提供重症监护的医院数量同时减少，而提供重症护理的医院总数增加 重症监护病房床位数量。因此，美国不仅提供了更多的重症监护服务，而且 也将这种护理集中在越来越少的医院中。在一个正在进行的职业发展奖中 (K08)由NHLBI资助，申请人正在研究这些变化对患者预后的临床影响 在区域层面上。然而，在这项工作的过程中，越来越清楚的是，信息是 不仅需要了解这些变化对人口的影响，而且还需要了解其根本原因和 在个别医院层面上的影响。该项目的总体目标是确定 从关键决策者的角度分析ICU床位数量在医院层面的变化。至 为了实现这一目标，我们将对医院管理人员进行半结构化访谈并进行分析 随着重症监护床位供应的增加、不变和减少。我们的研究有两个具体目标：1) 确定医院层面ICU床位数量变化的原因，以及2)评估感知的 ICU床位数量变化的影响。我们将对管理人员进行半结构化访谈 在ICU床位供应变化不同的医院。然后我们将对访谈进行主题内容分析 为ICU床位供应变化的潜在原因开发一个概念模型。我们将进一步 分析访谈记录以扩展我们的概念模型，将ICU床位变化的影响包括在内 从关键决策者的角度进行供应。这些目标的成功实现将产生丰富的 洞察ICU基础设施的变化如何影响运营、财务指标和临床结果，并将 为改善危重病人护理的组织战略提供新的假设。这些 数据将反过来提供给未来的R01提交的研究医院床位供应变化的影响 和地区层面的危重患者的临床结局，有助于NHLBI的战略愿景 了解造成人群健康差异的因素。此外，建议的 研究项目将为申请者提供一个接受额外指导研究的独特机会 定性研究方法和组织理论方面的培训。严谨的定性研究是一种 越来越重要的现代医疗保健提供科学的组成部分，但不是申请人的一部分 目前的K08，使这一建议与申请者的K08在科学和职业上都具有协同作用 发展观。最后，额外的培训、指导和经验与NHLBI的同步 发展一支能够应对当前和未来卫生挑战的科学队伍的战略愿景

In the last thirty years the United States witnessed a transformation of the critical care delivery system marked by a simultaneous decrease in the number of hospitals providing critical care and an increase in the total number of intensive care unit beds. As a consequence, the US is not only providing more intensive care, but also concentrating this care in ever fewer numbers of hospitals. In an ongoing career-development award (K08) funded by the NHLBI, the applicant is studying the clinical impact of these changes on patient outcomes at the regional level. However, in the course of this work it has become increasingly clear that information is needed on not only the population-based implications of these changes, but also their underlying causes and effects at the individual hospital level. The overall goal of this project is to determine the causes and effects of hospital-level changes in the number of ICU beds from the perspectives of key decision makers. To accomplish this goal we will conduct and analyze semi-structured interviews with administrators from hospitals with increasing, unchanged and decreasing intensive care bed supply. Our study has two specific aims: 1) to determine the causes of hospital-level changes in the number of ICU beds, and 2) to evaluate the perceived effects of changes in the number of ICU beds. We will conduct semi-structured interviews with administrators in hospitals with varying ICU bed supply changes. We will then use thematic content analysis of the interview transcripts to develop a conceptual model for the causes underlying ICU bed supply changes. We will further analyze the interview transcripts to expand our conceptual model to include the effects of changes in ICU bed supply from the perspectives of key decision makers. Successful completion of these aims will produce rich insight into how changes in ICU infrastructure affect operations, financial metrics and clinical outcomes and will provide new hypotheses for organizational strategies to improve the care of patients with critical illness. These data will in turn inform a future R01 submission studying the impact of changes in bed supply at the hospital and region level on clinical outcomes for critically ill patients, contributing to the NHLBI's strategic vision to understand factors that account for differences in heath among populations. Additionally, the proposed research project will provide a unique opportunity for the applicant to receive additional mentored research training in qualitative research methods and organizational theory. Rigorous qualitative research is an increasingly important component of modern health care delivery science but is not part of the applicant's current K08, making this proposal synergistic with the applicant's K08 both scientifically and from a career development standpoint. Finally, the additional training, mentoring and experience are in-step with NHLBI's strategic vision to develop a scientific workforce capable of responding to current and future health challenges