Reducing Ethnic-racial Disparities in Cardiac Arrest Survival Outcomes (RED-CASO)

减少心脏骤停生存结果的种族差异 (RED-CASO)

基本信息

批准号：
10338932
负责人：
Paul Sheung-Yan Chan
金额：
$ 67万
依托单位：
SAINT LUKE'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10338932
关键词：
911 call Accident and Emergency department Address Administrator Adopted Adoption Affect American Heart Association Baseline Surveys Black Populations Black race Blood Circulation Cardiology Cardiopulmonary Resuscitation Caring Cause of Death Censuses Centers for Disease Control and Prevention (U.S.)Communities Community Services Data Effectiveness Emergency Medicine Emergency medical service Ensure Epidemiology Ethnic Origin Face Fire - disasters Focus Groups Foundations Future Goals Heart Arrest Hispanic Hispanic Populations Hospitals Immigration Individual Interview Knowledge Language Life Low income Medical Staff Methodology Methods Mission Morbidity - disease rate National Heart, Lung, and Blood Institute Native Americans Neighborhoods Outcome Outcome Study Paramedical Personnel Patient-Focused Outcomes Patients Peer Review Persons Police Policies Practice Guidelines Pre-hospital setting Pre-hospitalization care Process Public Health Publications Registries Research Research Methodology Research Personnel Resources Resuscitation Risk Sampling Site Site Visit Surveys Survival Rate System Time Universities Variant Work care systems community engagement cost design disparity reduction emergency settings first responder health equity health equity promotion hispanic community improved improved outcome innovation insight mortality multidisciplinary novel out-of-hospital cardiac arrest premature racial and ethnic disparities response routine practice survival outcome

项目摘要

PROJECT SUMMARY / ABSTRACT The public health burden of out-of-hospital cardiac arrest (OHCA) is enormous, affecting ~350,000 individuals each year in the U.S. and is the third leading cause of death. To improve our understanding of OHCA, the Cardiac Arrest Registry to Enhance Survival (CARES) was launched by Emory University and the Centers for Disease Control and Prevention. Through >70 peer-reviewed publications over the past 2 decades, CARES has transformed our understanding of the epidemiology and outcomes of patients with OHCA. Yet, little is known as to how some emergency medical service (EMS) agencies achieve higher survival rates for their patients with OHCA than other agencies. While variation in OHCA survival is largely believed to be due to adoption of key care processes by EMS agencies in the prehospital setting, how these processes are employed in routine practice, the underlying factors contributing to their successful implementation, and effective interactions between EMS agencies with the community, first responders (e.g., police, fire), 911 dispatchers, and hospitals have not been systematically defined. Moreover, despite the fact that Black and Hispanic patients have lower survival rates for OHCA than White patients, there is scant research on how to reduce disparities in OHCA survival and how top-performing EMS agencies that work in majority Black or Hispanic communities overcome additional barriers to prehospital OHCA response and care. Accordingly, we propose the RED-CASO (Reducing Ethnic-racial Disparities in Cardiac Arrest Survival Outcomes) study to address these critical gaps in knowledge and to lay the foundation for quality improvement efforts to reduce disparities in OHCA survival. First, we will identify top-performing and bottom-performing EMS agencies in OHCA survival, with a focus on those that work in majority Black or Hispanic communities. Second, we will identify ‘best practices’ at top-performing EMS agencies in OHCA survival through detailed interviews with key stakeholders during site visits. We will intentionally sample EMS agencies which work in majority Black or Hispanic communities, and these agencies will comprise at least half of the sites visited. And third, we will validate these best practices associated with EMS agencies with the highest survival rates for OHCA. We will use a sequential mixed-methods approach with a focus on identifying best practices at top- performing EMS agencies which work in communities where most residents are Black or Hispanic. We will build on work by our investigative team to systematically understand factors associated with survival for other emergency settings (in-hospital cardiac arrest) and leverage our team’s multidisciplinary expertise in cardiology, emergency medicine, epidemiology, and mixed methods research. Findings from this study will be used to construct a ‘best practices guide’ for OHCA that can be implemented by EMS agencies both within CARES and with national partners such as the American Heart Association to improve OHCA survival in predominantly non-White communities and, in turn, reduce racial and ethnic disparities in OHCA outcomes.

项目摘要 /摘要院外心脏骤停（OHCA）的公共卫生烧伤非常巨大，影响了约35万人每年在美国，是死亡的第三大原因。为了提高我们对OHCA的理解，埃默里大学（Emory University）发起了增强生存（CARES）的心脏骤停登记处，疾病控制和预防。通过> 70个同行评审的出版物在过去20年中，关心已经改变了我们对OHCA患者的流行病学和结果的理解。但是，几乎没有众所周知某些紧急医疗服务（EMS）机构如何实现其更高的生存率 OHCA的患者比其他机构。虽然OHCA生存的差异很大程度上被认为是由于 EMS机构在院前环境中采用关键护理流程，这些过程是如何在常规实践中采用的，有助于其成功实施的基本因素，以及 EMS机构与社区，急救人员（例如警察，火灾）之间的有效互动，911 调度员和医院尚未系统地定义。此外，要承诺黑人和与白人患者相比，西班牙裔患者的生存率较低，关于如何处理如何减少OHCA生存中的分布，以及如何在多数黑色或以下表现的EMS机构西班牙裔社区克服了院前OHCA反应和护理的其他障碍。根据，我们提出了红色卡索（减少心脏骤停生存中种族差异结果）研究以解决知识中的这些关键差距并为质量提高奠定基础减少OHCA生存的分布的努力。首先，我们将确定表现最佳和表现效果的EMS OHCA生存的机构，重点是在大多数黑人或西班牙裔社区工作的机构。第二，我们将通过详细的OHCA生存中表现最佳的EMS机构确定“最佳实践” 在现场访问期间，对主要利益相关者的访谈。我们将故意采样EMS机构大多数黑人或西班牙裔社区，这些机构将至少完成参观的一半。和第三，我们将验证与EMS机构相关的这些最佳实践，其生存率最高 OHCA。我们将使用连续的混合方法方法，重点是确定顶级的最佳实践执行在大多数居民是黑人或西班牙裔社区工作的EMS机构。我们将在我们的调查团队的工作基础上建立系统地了解与其他生存相关的因素紧急情况（院内心脏骤停），并利用我们团队的多学科专业知识心脏病学，急诊医学，流行病学和混合方法研究。这项研究的发现将是用于构建OHCA的“最佳实践指南” 关心和与美国心脏协会等国家合作伙伴一起改善OHCA生存主要是非白人社区，进而减少OHCA成果中的种族和种族差异。