Characterizing the Impact of Fragmented Care in Acute Respiratory Failure

项目摘要/摘要 候选人的长期职业目标：成为一名使用先进技术的独立调查员 改善重症监护的组织和提供的观察性研究方法。 需要解决的临床问题：急性呼吸衰竭导致200万人住院和40万人 美国每年的死亡人数。不同医院的结果差异很大，这表明如何改进 护理的组织和提供可能会提高存活率。然而，影响住院护理团队的全球变化已经 鼓励碎片化-不连续的护理分散在多名医生之间。人们对此知之甚少 零散的护理影响患有呼吸衰竭的成年人，以及医院可以做些什么来保护患者免受伤害。 具体目标：使用先进的方法进行因果推理，应用于新的数据源，Admon博士将1) 比较分散护理对院内和院后呼吸衰竭结局的因果影响；2) 确定是否在分散的护理中发生特定并发症的频率更高，并预测更差的结果； 以及3)测试当护理支离破碎时，住院护理的特定特征是否具有防止伤害的作用。 候选人背景：安德鲁·阿德蒙博士是肺部和危重领域的讲师和研究员 密歇根大学的关怀医学。他接受过公共卫生和医疗保健方面的高级培训 研究。共发表论文25篇，其中原创研究稿件17篇，原创研究7篇 作为第一作者的手稿。阿德蒙博士的工作得到了NHLBI NRSA F32奖的支持。 职业发展计划：为了实现他的长期职业目标，阿德蒙博士寻求在以下方面进行深入、集中的培训 因果推理和调查方法论。因此，他的五年计划包括精心策划的课程 他在定量研究方面的雄厚基础，重症监护流行病学专家基于项目的指导， 因果推断和调查研究，选定的职业发展活动，以及具体的里程碑 确保向独立的成功过渡。阿德蒙博士的主要导师是科林·库克，医学博士，硕士，硕士。 他的共同导师是安德鲁·瑞安博士、莎拉·克莱恩博士、RN博士和西奥多·J·伊瓦希纳博士。 交付成果：完成本计划书中的研究和培训将生成数据，为以下战略提供信息 减少碎片化，同时为Admon博士配备观察因果推理和 调查方法。在随后的工作中，这些专业知识将为他最大限度地利用观测数据做好准备 产生及时和准确的证据，解决重症护理提供方面的其他研究挑战。

PROJECT SUMMARY/ABSTRACT Candidate’s Long-Term Career Goal: To become an independent investigator who uses advanced observational research methods to improve the organization and delivery of critical care. Clinical Problem to be Addressed: Acute respiratory failure leads to 2,000,000 hospitalizations and 400,000 deaths in the US each year. Outcomes vary widely across hospitals, suggesting that improvements to how care is organized and delivered may improve survival. Yet, global changes affecting inpatient care teams have encouraged fragmentation—discontinuous care spread across multiple physicians. Little is known about how fragmented care affects adults with respiratory failure and what hospitals can do to protect patients from harm. Specific Aims: Using advanced methods for causal inference applied to novel data sources, Dr. Admon will 1) compare the causal effects of fragmented care on in-hospital and post-hospital respiratory failure outcomes; 2) determine whether specific complications occur more often in fragmented care and predict poorer outcomes; and 3) test whether specific features of inpatient care are protective against harm when care is fragmented. Candidate’s Background: Dr. Andrew Admon is a Lecturer and Research Fellow in Pulmonary and Critical Care Medicine at the University of Michigan. He has advanced training in public health and health care research. He has 25 total publications, including 17 original research manuscripts, with 7 original research manuscripts as first author. Dr. Admon’s work is supported by an NHLBI NRSA F32 award. Career Development Plan: To meet his long-term career goal, Dr. Admon seeks deep, focused training in causal inference and survey methodology. Accordingly, his 5-year plan includes curated courses that build on his strong foundation in quantitative research, project-based mentoring by experts in critical care epidemiology, causal inference, and survey research, selected career development activities, and specific milestones to ensure a successful transition to independence. Dr. Admon’s primary mentor is Colin Cooke, MD, MS, MSc. His co-mentors are Andrew Ryan, PhD, Sarah Krein, PhD, RN, and Theodore J. Iwashyna, MD, PhD. Deliverables: Completing the research and training in this proposal will generate data informing strategies to mitigate fragmentation while equipping Dr. Admon with advanced skills in observational causal inference and survey methods. In subsequent work, this expertise will prepare him to maximally leverage observational data to generate timely and accurate evidence addressing other research challenges in critical care delivery.