A POPULATION BASED APPROACH TO IMPROVE OUTCOMES AFTER OUT-OF-HOSPITAL CARDIAC ARREST

摘要 院外心脏骤停是美国的一个主要死亡原因，影响了30多万美国公民 每年一次。医学研究所(IOM)最近发布了“提高心脏骤停患者存活率的策略： 尽管在理解和治疗方面的突破令人印象深刻，但有能力 始终如一地提供及时的干预和高质量的护理并不令人印象深刻。国际移民组织的工作 强调了利益攸关方之间的合作对于为非政府组织甲型肝炎患者提供最佳护理至关重要 是缺乏的。事实上，联合国人权事务高级专员办事处的管理和成果存在明显的地域差异，而且 领先的专业协会支持心脏骤停护理系统的发展。在一种新的生物系统中， 给定的社区取决于其个人(例如，年龄、并存情况)、医院特征(例如 靶向体温管理和早期心导管术的方案)，以及组织 护理系统(例如，被送往高容量中心的患者的百分比)。在目前的结构中，问责制 因为结果存在于提供者或设施级别，但不存在区域基准或激励措施来改进 在社区一级取得的联合国人权高专办成果。国际移民组织将总体人口健康定义为“所有人的健康” 生活在特定的地缘政治区域“，并鼓励卫生系统、医院和付款人建立系统 提供满足患者需求和改善总人口健康的护理。建议进行的研究 通过应用空间方法，开发了一种新的医疗保险受益人维持uchA的归因方法 确定自然发生的地理集群，不是由卫生系统从属关系定义的，而是由患者如何定义的 获得紧急情况下的医疗保健。界定区域边界允许对结果进行基准比较，以及 促进以人口为基础的激励措施的发展。这种方法可以直接转化为实践。 通过使用美国卫生与公共服务部部长所描述的基于人口的支付策略 并由医疗保险和医疗补助服务中心实施。目标1将描述现有的模式 甲型肝炎患者的医院利用情况。目标2将确定现有的医院空间集群，这些医院将 患有羟丙酮症的社区的成员。目标3将确定风险调整结果的可变性 人口水平。这项工作提供了脚手架，使构建新的支付模式成为可能 与国际移民组织关于总体人口健康的愿景一致，美国心脏协会努力建立 区域护理系统，以及合作医疗改善人口健康的努力。我们的研究团队，富豪 在卫生服务研究方法和应用于心脏骤停调查方面经验丰富，是独一无二的 准备进行这些研究，这些研究将建立在我们目前在R56机制下的工作基础上。

Abstract Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the US, affecting over 300,000 citizens annually. The Institute of Medicine (IOM) recently released “Strategies to Improve Survival from Cardiac Arrest: A Time to Act,” stating “although breakthroughs in understanding and treatment are impressive, the ability to consistently deliver timely interventions and high-quality care is less than impressive.” The IOM’s work highlighted that the cooperation between stakeholders essential to deliver optimal care for patients with OHCA is lacking. Indeed, marked geographic variability exists in the management and outcomes of OHCA, and leading professional societies support the development of cardiac arrest systems of care. OHCA survival in a given community is a function of its individuals (e.g. age, comorbid conditions), hospital characteristics (e.g. protocols for targeted temperature management and early cardiac catheterization), and organization of the system of care (e.g. percent of patients taken to high volume centers). In the current structure, accountability for outcomes resides at the provider or facility level, but no regional benchmarks or incentives exist to improve OHCA outcomes at the community level. The IOM defines total population health as “the health of all persons living in a specified geopolitical area” and encourages health systems, hospitals, and payers to create systems of care that meet the needs of patients and improve the health of the total population. The proposed study develops a new attribution method for Medicare beneficiaries sustaining OHCA by applying spatial methods to identify naturally occurring geographic clusters defined not by health system affiliation, but by how patients access healthcare for emergencies. Defining regional boundaries allows for benchmarking of outcomes, and facilitates development of population-based incentives. This approach can be directly translated into practice by using population-based payment strategies as described by the U.S. Secretary of Health & Human Services and implemented by the Centers for Medicare & Medicaid Services. Aim 1 will describe the existing patterns of hospital utilization for patients with OHCA. Aim 2 will identify existing spatial clusters of hospitals that treat members of a community with OHCA. Aim 3 will determine variability in risk-adjusted outcomes at the population level. This work provides the scaffolding to enable the construction of new payment models that are consistent with the IOM vision of total population health, the American Heart Association’s efforts to build regional systems of care, and the CMS efforts to improve population health. Our research team, richly experienced in health services research methods and application to cardiac arrest investigations, is uniquely positioned to conduct these studies, which will build on our current work under an R56 mechanism.