Reducing Rural Disparities in Cardiac Arrest Outcomes by Standardization of Care

摘要 与城市患者相比，农村地区心脏骤停患者的预后更差 地区这部分是由于社会经济差异影响心血管疾病的潜在风险， 紧急医疗服务的可用性和运输时间。此外，很少关注工作流程 恢复脉搏后的病人护理提高时间病人之间的护理标准化 到达急诊室通过其余的护理是一个重要的机会，以限制 农村地区的差距。该项目的假设是，趋势风险调整后， 随着时间的推移，在州一级的结果，结合复苏后护理的标准化，将改善 农村患者的治疗结果，从而减少全国各地的农村差距。该项目汇集了 流行病学、政策改革和定性研究方面的当地专门知识，以1）确定农村对 对缅因州心脏骤停后接受治疗的所有患者进行风险调整分析，以评估心脏骤停死亡率; 和2）开发一个多中心学习社区，用于超急性心脏骤停后管理， 治疗指标和实施标准化协议，以减少地域差异。在第一个目标中， 我们将利用全国可用的急诊医疗部门数据， 全州范围内的可用数据，以确定农村如何影响全州的总体结果，并确定 农村地区结果的差异。在第二个目标中，我们将在七个国家建立一个学习型社区。 在农村，区域和三级中心的中心，以实施既定的协议，为超急性 心脏骤停护理管理。我们将使用患者水平的数据来确定基线和随后的 基准数据，并衡量其随时间的变化，同时考虑到区域资源 和医疗保健系统的差异。该项目的完成是实现长期目标的关键一步， 长期目标是创造一种方法，以改善缅因州的护理系统，可以复制在其他国家 农村各州，这将减少与院外心脏骤停有关的农村健康差距。 该项目由Teresa May博士领导，她是一名具有重症监护背景的初级临床研究员， 神经重症监护，她最近完成了KL 2培训，在那里她研究了心脏术后的住院方面。 逮捕护理。在农村卫生研究、复杂的调查设计、数据 分析（Y。Jonk）以及增加农村地区临床试验和实施科学研究的机会 （R.克雷默），她很有可能成功。这个项目为梅博士提供了一个独特的机会， 在数据驱动的多中心学习社区开发方面积累经验， 提高复苏后护理效率。项目成果将适用于周边其他农村地区， 国家，增加这项研究的影响。

Abstract Patients in rural areas who suffer a cardiac arrest have had worse outcomes compared to those in urban areas. This is due in part to socioeconomic disparities influencing the underlying risk of cardiovascular disease, availability of emergency medical services, and transport time. In addition, little attention is paid to the workflow of patient care after a pulse has been restored. Improving standardization of care between the time patients arrive in the emergency department through the remainder of their care is an important opportunity to limit the disparities seen in rural areas. The hypothesis that underlies this project is that trending risk-adjusted outcomes over time at a state-level, combined with standardization of post-resuscitation care, will improve outcomes for rural patients and thus decrease rural disparities across the state. This project brings together local expertise in epidemiology, policy reform and qualitative studies to 1) determine the influence of rurality on cardiac arrest mortality using risk-adjusted analysis of all patients treated after cardiac arrest across Maine; and 2) develop a multi-center learning community for hyper-acute post-cardiac arrest management to measure treatment metrics and implement standardization protocols to reduce geographical disparities. In the first aim, we will utilize nationally available emergency medical department data to perform a risk-adjusted analysis of statewide available data to determine how rurality affects overall outcomes across the state and identify the variability of outcome among rural areas. In the second aim, we will develop a learning community in seven centers across rural, regional and tertiary centers to implement established protocols for the hyper-acute management of cardiac arrest care. We will use patient-level data to determine baseline and subsequent benchmark data and measure how this changes over time, while taking into consideration regional resources and differences in health care systems. The completion of this project is a critical step in achieving the long- term goal of creating a method to improve systems of care for the state of Maine that can be replicated in other rural states, which will reduce rural health disparities related to out-of-hospital cardiac arrest. This project is led by Dr. Teresa May, a junior clinical researcher with a background in critical care and neurocritical care who recently completed KL2 training where she studied in-hospital aspects of post-cardiac arrest care. With strong mentorship in the areas of rural health research, complex survey designs, data analysis (Y. Jonk) and increasing access to clinical trials in rural areas and implementation science research (R. Kramer), she is well positioned to succeed. This project represents a unique opportunity for Dr. May to develop experience in data-driven development of multi-center learning communities to standardize and improve efficiency of post-resuscitation care. Project results will be applicable to other rural areas around the country, increasing the impact of this research.