The Role of Ambulatory Care in Reducing the Burden of Respiratory Failure

项目摘要/摘要 需要解决的临床问题：呼吸衰竭导致每年80万人住院并离开 幸存者处于以高再住院率、致残率和死亡率为标志的脆弱状态。到目前为止， 呼吸衰竭结果的改善很大程度上是通过以医院为基础的干预措施。这个 门诊护理环境可能是进一步改善发病率和 这种疾病导致的死亡率，尽管先前研究这种关系的工作有限。这个 这项工作的总体假设是，使用非卧床护理可以减少呼吸衰竭的影响 两个关键时间点：通过降低高危患者的呼吸衰竭发生率和通过改善术后 幸存者的住院结果。 具体目标：在目标1中，阿德蒙博士将量化特征之间的个体层面的联系 高危患者的门诊护理使用情况和呼吸衰竭发生率。为了实现这一目标，他将 将生存分析应用于关联的住院和门诊医疗保险索赔的数据集，同时调整 患者、医院和地区层面的混杂因素。在目标2中，阿德蒙博士将评估出院后 在呼吸衰竭幸存者中，门诊护理的可获得性和利用率影响再住院率。至 为了评估这一点，他将把现代流行病学方法应用于《健康》杂志上独特的纵向调查数据 和退休研究与相关的医疗保险索赔。最终，实现这些目标将奠定基础 为后续工作开发一种以门诊护理为基础的干预措施，以减少呼吸道感染的影响 失败了。 奖学金培训计划和环境：阿德蒙博士的长期目标是成为一名独立的 内科医生-科学家，通过重症监护健康改善呼吸衰竭患者的护理 服务研究。拟议的奖学金将支持这一目标，允许他参与密集的 指导研究、授课课程和策划开发活动，所有这些都是在与他的 导师们支持他特定的学术目标。通过这样做，他将建立在坚实的基础上，通过 发展先进的统计和流行病学方法、纵向调查数据和 不定期的索赔。他的导师在帮助初级教员实现独立方面经验丰富 他从事学术事业，并亲自致力于支持他的学术和职业成长。

PROJECT SUMMARY/ABSTRACT Clinical Problem to be Addressed: Respiratory failure leads to 800,000 hospitalizations per year and leaves survivors in a vulnerable state marked by high rates of rehospitalization, disability, and death. To date, improvements in respiratory failure outcomes have come largely through hospital-based interventions. The ambulatory care environment may represent an additional opportunity to further improve rates of morbidity and mortality stemming from this disease, though prior work examining this relationship has been limited. The overall hypothesis of this work is that the use of ambulatory care reduces the impact of respiratory failure at two key time points: by reducing rates of respiratory failure among patients at risk and by improving post- hospitalization outcomes among survivors. Specific Aims: In aim 1, Dr. Admon will quantify the individual-level association between characteristics of ambulatory care use and rates of respiratory failure among patients at risk. In order to accomplish this, he will apply survival analysis to a dataset of linked inpatient and outpatient Medicare claims while adjusting for patient, hospital, and region-level confounders. In aim 2, Dr. Admon will evaluate whether post-discharge ambulatory care access and utilization influence rates of readmission among survivors of respiratory failure. To assess this, he will apply modern epidemiological methods to the unique, longitudinal survey data in the Health and Retirement Study with linked Medicare claims. Ultimately, accomplishing these aims will lay the foundation for subsequent work developing an ambulatory care-based intervention that reduces the impact of respiratory failure. Fellowship Training Plan and Environment: Dr. Admon’s long-term goal is to become an independent physician-scientist who improves the care of patients with respiratory failure through critical care health services research. The proposed fellowship will support this goal by allowing him to engage in intensive mentored research, didactic coursework, and curated development activities, all chosen in consultation with his mentors to support his particular academic goals. In doing so, he will build on a strong foundation by developing expertise in advanced statistical and epidemiological methods, longitudinal survey data, and ambulatory claims. His mentors are experienced in helping junior faculty members achieve independent academic careers and are personally committed to supporting his academic and professional growth.