# Use of systems engineering to evaluate the initiation of life-supporting treatments in older adults with life-limiting illness

> **NIH NIH K24** · UNIVERSITY OF WISCONSIN-MADISON · 2021 · $142,660

## Abstract

ABSTRACT
In the final six months of life older adults often receive invasive treatments despite their preferences to avoid
burdensome interventions with limited efficacy. Strategies to reduce overtreatment at the end of life have
focused on improving communication and decision making, yet systems-level practice patterns have a strong
influence on the delivery of patient care. My patient-oriented research program focuses on improving major
treatment decisions for older adults with serious illness. As a sought after mentor for early-career investigators,
I now wish to expand my research program to include the human factors and systems-level forces that lead to
these decisions and build a robust pipeline of researchers focused on improving care for older adults.
Use of systems engineering to evaluate the initiation of life-supporting treatments in older adults with
life-limiting illness is a five-year K24 Midcareer Investigator's Award in patient-oriented and aging research
responding to PA-20-186. Our research team has previously recognized systems-level practice patterns
leading to overtreatment and developed a conceptual model to describe this phenomenon that we call clinical
momentum. We theorize that clinical momentum is a major contributor to overtreatment for older adults with
life-limiting illness and is an important barrier to the success of communication interventions designed to
improve care at the end of life. The objective of this proposal is to use a systems engineering approach to
characterize the systems in which decisions about life-supporting treatments occur and to employ user-
centered design to generate interventions to improve patient, clinician and organizational outcomes. In this
observational study we will perform a comparative analysis of the initiation of life-supporting treatments,
specifically dialysis, feeding tube placement, and prolonged mechanical ventilation, which will provide a rich
laboratory for a variety of mentored projects. For aim 1, we will use a systems engineering approach to
characterize patterns of care leading to initiation of life-supporting treatments. For aim 2, we will develop
interventions to disrupt clinical momentum for older adults with life-limiting illness.
This award will allow me to (1) build a new direction of research and investigative skills and (2) expand my
capacity and skill as a mentor and to increase the number of young investigators who aim to develop a career
in patient-oriented and aging research. This research is innovative because it uses a novel empirical strategy
to identify practice patterns that may play a critical role in the provision of overtreatment for older adults with
life-limiting illness. This research is significant because characterizing the role of clinical momentum in the
initiation of life-supporting treatments has the potential to unlock the pathway to care truly driven by patient
preferences instead of systems-level incentives and forces. With my strong ment...

## Key facts

- **NIH application ID:** 10281269
- **Project number:** 1K24AG073476-01
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Margaret Schwarze
- **Activity code:** K24 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $142,660
- **Award type:** 1
- **Project period:** 2021-09-15 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10281269

## Citation

> US National Institutes of Health, RePORTER application 10281269, Use of systems engineering to evaluate the initiation of life-supporting treatments in older adults with life-limiting illness (1K24AG073476-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10281269. Licensed CC0.

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