Which palliative care quality measures improve patient-centered outcomes?

 描述(申请人提供)：我的职业目标是成为一名独立的健康服务研究员，专注于高质量和姑息治疗，改善严重和慢性病患者及其照顾者的体验。姑息治疗是一种较新的临床疗法 纪律侧重于提高所有患者的生活质量，独立于预后。姑息治疗取得了显著增长，66%的医院提供了临床服务。尽管有这样的增长，标准化的临床方法还不存在。这种方法需要评估已公布的质量指标推荐的哪些护理过程最能改善以患者为中心的结果。然后，可以对影响最大的护理过程和相关质量措施进行优先排序。我们已经开发了执行这项调查的基础设施。具体地说，我领导了QDACT-PC(Quality Data Collection Tool Palliative Care)的开发，这是一个基于iPad(Tm)的医疗点数据收集系统，可同时填充护理过程、质量测量遵守情况以及患者和健康系统结果的注册表。2013年9月，我们获得了AHRQ R18拨款，在全国范围内实施姑息治疗研究合作小组(PCRC)的QDACT-PC，这是第一个全国性的姑息治疗研究合作组织。我的导师和该提案的PI艾米·阿伯内西博士为这份K08申请保留了分析目标。我的研究目标是利用这一快速增长的注册来探索在姑息治疗环境中遵守质量衡量标准对结果的影响。在我的导师的指导下，我将首先描述临床医生在1000名患者中遵守一套20项核心姑息治疗质量指标的差异性。然后，我将使用定量和定性的方法来确定遵守一套姑息治疗质量衡量标准与患者报告的结果之间的关系，包括对治疗的满意度、生活质量和症状缓解。最后，我将调查遵守一套质量措施与卫生服务利用之间的关系，通过30天的再住院率、住院时间和总体卫生保健成本来衡量。这些目标加上强大的职业发展计划和专注的指导，将使我为R01级的提交做好准备，前瞻性地测试以患者为中心的已确定的核心结果集。

 DESCRIPTION (provided by applicant): My career goal is to mature as an independent health services researcher, with a focus on quality and palliative care, to improve the experience of patients with serious and chronic illness and their caregivers. Palliative care is a newer clinical discipline focused on improving quality of life for all patients, independent of prognosis. Palliative care has achieved remarkable growth, with clinical services present in 66% of all hospitals. Despite such growth, a standardized clinical approach does not yet exist. Such an approach requires evaluating which care processes, recommended by published quality measures, improve patient-centered outcomes the most. Then, the care processes and associated quality measures with the greatest impact can be prioritized. We have developed the infrastructure to perform this investigation. Specifically, I led the development of QDACT-PC (Quality Data Collection Tool Palliative Care), a point-of-care, iPad(tm)-based data collection system that simultaneously populates a registry of care processes, quality measure adherence, and patient and health system outcomes. In September 2013, we were awarded an AHRQ R18 grant to implement QDACT-PC nationally in the Palliative Care Research Cooperative Group (PCRC), the first national research collaborative for palliative care. Analysis aims were reserved by my mentor and the PI of that proposal, Dr. Amy Abernethy, for this K08 application. My research goal is to use this quickly growing registry to explore the impact of quality measure adherence on outcomes in the palliative care setting. Under the guidance of my mentors, I will first, I will describe variability in clinician adherence to a set of 20 core palliative care qualiy measures among 1000 patients. Then, I will use quantitative and qualitative methods to determine the relationship between adherence to a set of palliative care quality measures and patient-reported outcomes, including satisfaction with care, quality of life, and symptom relief. Last, I will investigate the relationship between adherence to a set of quality measures and health service utilization, as measured by 30-day readmission rates, length of stay, and overall health care costs. Together, these aims alongside a robust career development plan and dedicated mentorship, will prepare me for an R01-level submission prospectively testing the identified core set on patient-centered outcomes.