Developing a National Pediatric Hospital Medicine Randomized Controlled Trial Agenda

项目总结 儿科住院在美国很常见，费用也很高，但缺乏证据来指导 照顾和确保住院儿童的最佳健康结果。在美国，有600多万人 每年儿科住院，导致总成本近500亿美元。童年的大部分时间 住院是针对常见疾病的，但目前，在如何最好地治疗的证据方面存在重大差距 关心这些情况(例如，对儿童来说，什么是最有效的全身皮质类固醇方案 因哮喘住院？“)。此外，超过70%的美国儿童在社区医院住院，但 联邦政府为儿科研究提供的绝大部分资金都拨给了独立的儿童医院。证据 社区医院环境中的差距和研究匮乏导致了以下方面的健康结果不佳 住院儿童，如不必要的治疗引起的并发症，住院时间延长，住院 重新入院，慢性病控制不力。随机对照试验(RCT)可以引导证据- 以儿童为基础的保健和改善儿童健康结果。随机对照试验通过以下方式最大限度地减少研究结果中的潜在偏见 将研究参与者随机分配到治疗组。因此，它们代表了最高质量的 指导住院儿童护理工作。 我们的总体目标是制定儿科医院医学(PHM)和危重疾病的国家随机对照试验议程 实现这一议程所需的资源。为了实现这一目标，我们建议举行一次研究开发 会议。我们为这次会议招募了一批不同的PHM利益相关者，包括 来自儿童和社区医院的多学科PHM临床医生(例如，医生、护士、 药剂师)、临床和卫生服务研究人员、患者和家属、卫生公平专家以及 政策制定者。在目标1中，我们将邀请与会者使用一种既定的方法、概念 为PHM中最常见的20种情况确定RCT问题并确定其优先顺序。在目标2中，我们 将确定在社区医院开展PHM随机对照试验的障碍和促进者。在《目标3》中，我们将 通过三个国家伙伴组织传播会议成果。 我们提议的会议将通过制定一个可操作的国家PHM研究议程来填补关键空白， 确定有意义地让儿童和社区医院参与实现这一目标的战略 议程，并召集执行这一议程的关键合作伙伴。这些发现将具有重要的意义 通过指导未来的研究工作以改善儿童的医院护理和健康结果，产生积极影响， AHRQ优先考虑的人口。因此，这项工作与AHRQ的使命一致，即提供证据以使健康 护理更安全、更高质量。

PROJECT SUMMARY Pediatric hospitalizations are common and costly in the US, yet there is a scant evidence base to guide care and ensure the best health outcomes for hospitalized children. In the US, there are over 6 million pediatric hospitalizations annually, leading to aggregate costs of nearly $50 billion. The majority of childhood hospitalizations are for common conditions, but currently, there are major gaps in the evidence of how best to care for these conditions (e.g., “what is the most effective systemic corticosteroid regimen for children hospitalized with asthma?”). Additionally, over 70% of US children are hospitalized in community hospitals, but the vast majority of federal funding for pediatric research goes to free-standing children’s hospitals. Evidence gaps and the scarcity of research in community hospital settings contribute to suboptimal health outcomes for hospitalized children, such as complications from unnecessary treatments, prolonged hospital stays, hospital readmissions, and poor chronic disease control. Randomized controlled trials (RCTs) can guide evidence- based care and improve child health outcomes. RCTs minimize potential biases in research findings by randomly allocating study participants to treatment groups. Thus, they represent the highest-quality studies for guiding the care of hospitalized children. Our overall objective is to develop a national RCT agenda in pediatric hospital medicine (PHM) and critical resources for achieving that agenda. To achieve this objective, we propose to hold a research development conference. We have recruited a diverse group of PHM stakeholders for this conference, including multidisciplinary PHM clinicians from children’s and community hospitals (e.g., physicians, nurses, pharmacists), clinical and health services researchers, patients and families, health equity experts, and policymakers. In Aim 1, we will engage conference attendees in using an established method, concept mapping, to identify and prioritize RCT questions for the 20 most prevalent conditions in PHM. In Aim 2, we will identify barriers and facilitators to conducting PHM RCTs in community hospitals. In Aim 3, we will disseminate conference findings via three national partner organizations. Our proposed conference will fill critical gaps by setting an actionable national PHM research agenda, identifying strategies for meaningfully engaging both children’s and community hospitals in achieving this agenda, and assembling critical partners for carrying out this agenda. These findings will have an important positive impact by guiding future research efforts to improve hospital care and health outcomes for children, an AHRQ priority population. Thus, this work aligns with AHRQ’s mission to produce evidence to make health care safer and higher quality.