Delivering Hospice and Palliative Care Services to Nursing Home Patients

描述(由申请人提供)：本申请提出了一个5年的职业发展和研究计划，以支持候选人获得所需的知识和研究技能，以成为以患者为导向的老龄化研究的独立研究员。候选人和她的导师设计的职业发展计划是为了承认建立专注于疗养院环境的研究职业所需的特殊技能、经验和关系。培训计划包括通过印第安纳大学临床调查和转换教育(CITE)计划获得临床研究硕士学位的正式课程，以及获得姑息治疗和养老院实践方面更多专业知识的校外培训活动。拟议的研究项目“为疗养院患者提供临终关怀和姑息关怀服务”将与大型多州临终关怀和姑息关怀提供者Seasons临终关怀合作进行。我们可以访问2006-2012年间登记的50,000多名临终关怀患者的详细患者护理记录，以及大约1,000名非临终关怀姑息咨询患者。在这个数据库中，近三分之一的临终关怀患者和姑息治疗患者咨询了住在养老院的患者。临终关怀记录与家庭临终关怀评估调查结果相关联，该调查结果提供了与多个领域的感知护理质量相关的信息。尽管临终关怀的使用出现了巨大的增长，但很少有关于向患者提供实际服务的研究，包括所涉及的提供者的组合和临终关怀过程中的服务强度。在接受不同临终关怀诊断的患者，或者住在家里或疗养院的患者，获得一揽子服务的方式各不相同，但没有得到很好的描述。此外，有一批疗养院患者需要姑息治疗，但他们不符合临终关怀资格标准。在一些市场上可以获得外部姑息治疗咨询，但只是轶事般的描述。项目的具体目标如下，旨在填补这些空白：1)提供疗养院患者所接受的具体临终关怀服务的现代描述，包括个别临终关怀专业人员和志愿者访问的总数和持续时间；2)比较住在疗养院的临终关怀患者和在家中的临终关怀患者获得的服务量，并将服务与患者结果相关；以及3)检查接受非临终关怀姑息咨询的疗养院患者的特征和顾问提供的建议的内容，包括最终转介到临终关怀中心。总而言之，比森职业发展奖将为我过渡到独立调查员提供关键支持，因为我通过实践积累了专业知识 在疗养院护理、姑息治疗和临终关怀方面的经验和指导，以及通过严格的正规课程计划加强我在关键研究技能方面的基础。除了通过访问这个临床数据库进行可能的分析外，与大型国家临终关怀提供者的合作将支持未来以患者为导向的原始数据收集。

DESCRIPTION (provided by applicant): This application proposes a 5 year career development and research plan to support the candidate's acquisition of the knowledge and research skills needed to become an independent investigator in patient- oriented aging research. The career development plan designed by the candidate and her mentors is tailored to acknowledge the special skills, experiences, and relationships needed to build a research career focused in the nursing home setting. The training plan includes formal coursework to earn a Master's Degree in Clinical Research through the Indiana University Clinical Investigation and Translational Education (CITE) program, as well as extramural training activities to obtain additional expertise in palliative care and nursing home practice. The proposed research project, "Delivering Hospice and Palliative Care Services to Nursing Home Patients," will be conducted in partnership with a large multi-state hospice and palliative care provider, Seasons Hospice. We have access to the detailed patient care records of over 50,000 hospice patients enrolled from 2006-2012, as well as about 1,000 non-hospice palliative care consult patients. Nearly 1/3 of both the hospice patients and the palliative care consult patients in this database lived in nursing homes. The hospice records are linked to the Family Evaluation of Hospice Care survey results, which provide information related to perceived quality of care in multiple domains. Despite the tremendous growth that has occurred in the use of hospice care, there have been few studies of the actual services delivered to patients, including the mix of providers involved and the intensity of services over the course of the hospice episode. The ways in which the package of services received varies among patients with differing hospice diagnoses, or who live in their homes vs. nursing homes, are not well described. Further, there is a population of nursing home patients with palliative care needs who do not meet hospice eligibility criteria. Outside palliative care consultation is available in some markets but has only been anecdotally described. The specific aims of the project, outlined below, are designed to fill these gaps: 1) Provide a modern description of the specific hospice services received by nursing home patients, including the overall number and duration of visits by individual hospice professionals and volunteers; 2) Compare the volume of services received by hospice patients living in a nursing home versus those at home and correlate services with patient outcomes; and 3) Examine the characteristics of nursing home patients who received non-hospice palliative care consults and the content of recommendations provided by consultants, including eventual referral to hospice. In summary, the Beeson Career Development Award will provide critical support for me in my transition to independent investigator, as I build expertise through practical experiences and mentorship in nursing home care, palliative care, and hospice, as well as strengthen my foundation in key research skills through a rigorous program of formal coursework. In addition to the analyses possible through access to this clinical database, partnership with a large, national hospice provider will support future patient-oriented original data collection.