ICU Discharge: A Critical Juncture for Survivors of Acute Respiratory Failure

描述（由申请人提供）：此培训补助金正在寻求由医学博士，博士生准备进入她的博士学位在临床流行病学的论文阶段。候选人渴望成为重症监护结果研究领域领先的独立医生科学家。她将在博士期间投入100%的时间进行这项研究。她在她的论文阶段的实践培训，再加上精心挑选的教学课程，旨在使她在使用先进的统计方法来定义重症监护暴露和结果之间的关联，以及在使用定性方法深入探索机制，并产生新的假设专家。这种双重培训方法将为她在重症患者护理过渡期间进行医患沟通的未来研究做好最佳准备。在整个奖项中，她将由卫生服务研究，重症监护，生物统计学，生物伦理学和定性方法的高级专家指导。该职业发展奖的研究部分将在三个免费项目中进行，以提高对ICU出院情况如何影响急性呼吸衰竭（ARF）患者及其代理人结果的理解。在项目1中，候选人将使用ICU患者的国家数据库检查ICU普查对ARF患者的医疗结果的影响。首先，她将评估ICU普查对需要机械通气的ARF患者拔管和ICU出院时间的影响。然后，她将研究ICU人口普查与院内死亡和ICU再入院之间的关系，调查拔管和ICU出院之间的时间是否作为人口普查和阴性结果之间的影响因素。在项目2中，她将前瞻性地收集数据，以检查需要机械通气的ARF发作患者及其代理人的心理和信任结果。她将在ICU出院后一个月对患者和代理人进行电话采访，并进行经验证的调查，评估焦虑，抑郁和信任结果。因此，这项研究将产生有效的措施，以前未探索的风险周围的时间出院的ARF患者需要机械通气和他们的替代品。它将建立一个概念模型的基础，该模型将用作未来定性研究的基础，这些研究将检查ICU出院时医疗保健团队与患者和代理人之间的对话内容，以确定患者和代理人发现哪些沟通元素最有帮助。最终目标是改善这一弱势群体患者和代理人的结局，未来的干预研究针对床位分配决策以及医疗团队与患者和代理人之间的沟通。 公共卫生相关性：从ICU出院的时间和情况可能是急性呼吸衰竭发作后存活的患者及其替代者的长期结局的关键决定因素。使用定量和调查方法，本研究将确定周围的ICU出院的情况下，预示着不良的临床结果，从而阐明干预措施，以改善护理这一弱势群体的患者及其代理人的目标。

DESCRIPTION (provided by applicant): This training grant is being sought by an MD-PhD student preparing to enter the dissertation phase of her PhD in clinical epidemiology. The candidate aspires to become a leading independent physician-scientist in the field of critical care outcomes research. She will devote 100% of her time to this research for the duration of her PhD. Her hands-on training during her dissertation phase, coupled with carefully selected didactic courses, are designed to make her expert in the use of advanced statistical methods to define associations between critical care exposures and outcomes as well as in the use of qualitative methods to deeply explore mechanisms and generate new hypotheses. This dual training approach will optimally prepare her for future studies on doctor-patient communication during transitions of care for critically ill patients. Throughout this award, she will be mentored by senior experts in health services research, critical care, biostatistics, bioethics, and qualitative methods. The research portion of this career development award will proceed in three complimentary projects to improve understanding of how the circumstances surrounding ICU discharge affect the outcomes for acute respiratory failure (ARF) patients and their surrogates. In project 1, the candidate will examine the effect of ICU census on the medical outcomes of ARF patients using a national database of ICU patients. First, she will evaluate the effect of ICU census on the time between extubation and ICU discharge for ARF patients requiring mechanical ventilation. She will then examine the relationship between ICU census and in-hospital death and ICU readmission, investigating whether time between extubation and ICU discharge acts as an effect modifier between census and negative outcomes. In project 2, she will prospectively collect data to examine psychological and trust outcomes patients who suffered an episode of ARF requiring mechanical ventilation and their surrogates. She will conduct telephone interviews with patients and surrogates one month following ICU discharge and administer validated surveys that assess anxiety, depression, and trust outcomes. This research will therefore produce valid measures of the previously unexplored risks surrounding the time of discharge to ARF patients requiring mechanical ventilation and their surrogates. It will build the foundations of a conceptual model that will be used as the basis for future qualitative studies that examine the content of conversations between the health care team and patients and surrogates at the time of ICU discharge to determine which communication elements patients and surrogates find most helpful. The ultimate goal is to improve outcomes in this vulnerable group of patients and surrogates with future intervention studies targeting bed allocation decisions and communication between the health care team and patients and surrogates. PUBLIC HEALTH RELEVANCE: The timing and circumstances of discharge from the ICU may be critical determinants of longer-term outcomes for patients surviving an episode of acute respiratory failure and their surrogates. Using quantitative and survey methods, this research will identify circumstances surrounding ICU discharges that portend adverse clinical outcomes, thereby elucidating targets for interventions to improve care for this vulnerable group of patients and their surrogates.