Using Outcomes to Guide Treatment of Surgical Emergencies

利用结果指导外科紧急情况的治疗

• 批准号: 10370161
• 负责人: Rachel Kelz
• 金额: $ 8.99万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10370161
• 关键词: Accident and Emergency department; Acute; Address; Adult; Caring; Characteristics; Clinical; Complication; Coronary heart disease; Data; Dementia; Development; Diabetes Mellitus; Diagnosis; Effectiveness; Elderly; Emergency Care; Emergency Situation; Emergency treatment; Evaluation; Financial Hardship; Future; HIV; Health system; Heart; Heart failure; Heterogeneity; Hospitalization; Hospitals; Inferior; Institute of Medicine (U.S.); Intervention; Investigation; Knowledge; Literature; Malignant Neoplasms; Medicare; Methods; Modeling; Nature; Observational Study; Operative Surgical Procedures; Outcome; Patient-Focused Outcomes; Patients; Performance; Policy Maker; Population; Provider; Public Health; Race; Randomized; Reporting; Risk; Selection Bias; Stroke; Surgeon; System; Time; Treatment outcome; United States; Variant; adverse outcome; age effect; beneficiary; care seeking; care systems; comparative; comparative effectiveness; comparative effectiveness analysis; comparative effectiveness study; control trial; cost; high risk; hospital performance; inpatient service; insight; interest; mortality; older patient; operation; readmission rates; surgery outcome; treatment comparison

Emergency general surgery (EGS) conditions are defined by a group of acute, non-trauma diagnoses that require presentation to an emergency department for operative or non-operative care. In are all The heart comprise overall with reasonable nature trials operative method of inferior the US alone, 3-4 million adults hospitalized and treated for an EGS condition each year such that EGS conditions are responsible for 7% of hospitalizations. EGS conditions result in an estimated 800,000 operations annually and cost ≈ $28 billion. burden of EGS on inpatient care is greater than that of a new diagnosis of diabetes or cancer, coronary disease, heart failure, stroke, or HIV. Older adults, who are at increased risk of adverse outcomes, more than half of the adult EGS population. Operative management of EGS conditions results in an complication ate of 50%, with a readmission rate of 4-18%, and a mortality rate that can approach 15%, older patients demonstrating a significantly higher risk. Non-operative management is considered a alternative yet studies show mixed results. Randomized control trials are limited by the invasive of operative treatment, the heterogeneity of conditions, and the acute nature of EGS. Furthermore, most have compared different types of operative or non-operative interventions, with relatively few comparing treatment to non-operative treatment. To date, observational studies o EGS outcomes by treatment are limited in number and subject to selection bias. A lack of evidence on the comparative effectiveness operative and non-operative treatment has been shown to result in unnecessary variations in treatment and operative outcomes. r f Furthermore, given the growing interest in the development of a regionalized system of care for EGS patients since the Institute of Medicine Committee report on the Future of Emergency Care in the United States Health System, knowledge on hospital performance in EGS is needed. This address these gaps in the literature with the following specific aims: (1) To identify hospital-level factors associated with rankings on performance in EGS to inform strategies on regionalization, (2) To evaluate the proposal aims to comparative effectiveness of operative and non-operative treatment in specific EGS conditions and (3) To evaluate dementia and race will be examined amongst others. U study EGS. approach examine will effectiveness and heterogeneity in the effectiveness of operative treatment in EGS conditions sing data from Medicare beneficiaries, the proposed will e the first nationwide comparative effectiveness analysis of operative and non-operative treatment in The proposal employs: (1) template matching to define hospital quality in EGS (2) an instrumental variable with optimal near-far matching to overcome onfounding by indication and, (3) interaction models to the conditional r elationship between treatment and outcomes by patient factors. In so doing the findings provide insights into hospital factors necessary for optimal EGS outcomes and establish the comparative of OP of EGS conditions to inform further investigations and ongoing practices. Patients, providers Medicare will benefit from the resultant high value care in EGS. . Conditional effects of age, b c ,

急诊普通外科（EGS）条件是由一组急性，非创伤诊断，需要 在急诊科进行手术或非手术护理。在 是 所有 的 心脏 包括 整体 与 合理 性质 试验 执行部分 方法 的 劣质 仅在美国，就有300万至400万成年人 每年因EGS状况住院和治疗，使得EGS状况负责7%的 住院治疗环境商品和服务条件每年造成估计80万次手术，耗资280亿美元。 EGS对住院治疗的负担大于新诊断的糖尿病或癌症、冠状动脉粥样硬化和心血管疾病。 心脏衰竭中风或艾滋病老年人，谁是在不良后果的风险增加， 超过一半的成年EGS人口。EGS条件的手术管理导致 并发症发生率为50%，再入院率为4- 18%，死亡率可接近15%， 老年患者的风险明显更高。非手术治疗被认为是 然而，其他研究显示出好坏参半的结果。随机对照试验受到侵入性 手术治疗，条件的异质性，和急性EGS的性质。而且大多数 比较了不同类型的手术或非手术干预， 非手术治疗。迄今为止，按治疗进行的EGS结局的观察性研究 在数量上是有限的，并且受到选择偏差的影响。缺乏关于比较有效性的证据 手术和非手术治疗已被证明会导致治疗中不必要的变化， 手术结果。 R F 此外，鉴于对发展区域化系统的兴趣日益增加， 自医学研究所委员会关于急诊护理未来的报告以来， 美国卫生系统，在EGS医院性能的知识是必要的。这 在文献中解决这些差距，具体目标如下：（1）确定医院层面的因素 与环境商品和服务业绩排名相关联，为区域化战略提供信息;（2）评价 提案旨在 手术和非手术治疗在特定EGS条件下的比较有效性;（3） 评价 痴呆症和种族等问题也将受到审查。U 研究 EGS。 方法 审查 将 有效性 和 EGS条件下手术治疗有效性的异质性 从医疗保险受益人的数据来看， 将首次在全国范围内对手术和非手术治疗进行比较有效性分析， 该建议采用：（1）模板匹配来定义EGS中的医院质量（2）工具变量 用最佳远近匹配来克服指示的混淆，以及（3）交互模型， 治疗与患者因素结局之间的条件关系。在这样做的时候， 提供对最佳EGS结局所需的医院因素的见解，并建立比较 环境商品和服务条件的业务方案，为进一步调查和正在进行的做法提供信息。患者，供应商 医疗保险将受益于由此产生的高价值护理EGS。 .年龄的条件效应， B C ,