Developing a National Pediatric Hospital Medicine Randomized Controlled Trial Agenda

项目摘要 儿科住院治疗在美国很常见，费用也很高，但缺乏证据基础来指导 护理和确保住院儿童的最佳健康结果。在美国， 每年儿科住院，导致近500亿美元的总成本。童年的大部分 住院治疗是常见的条件，但目前，在如何最好地 注意这些情况（例如，“儿童最有效的全身皮质类固醇方案是什么 哮喘病住院？”）。此外，超过70%的美国儿童在社区医院住院， 联邦对儿科研究的绝大多数资助都流向了独立的儿童医院。证据 社区医院环境中的研究差距和缺乏导致了次优的健康结果， 住院儿童，如不必要的治疗引起的并发症，住院时间延长， 再入院和慢性病控制不佳。随机对照试验（RCT）可以指导证据- 基础护理和改善儿童健康成果。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倚： 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研究， 指导住院儿童的护理。 我们的总体目标是在儿科医院医学（PHM）和关键领域制定国家RCT议程。 为实现这一目标提供资源。为达致这个目标，我们建议举办一项研究发展活动， 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，患者和家庭，健康公平专家，以及 政策制定者。在目标1中，我们将使用一种既定的方法、概念 映射，以确定和优先考虑PHM中20种最常见疾病的RCT问题。在目标2中， 将确定在社区医院开展PHM RCT的障碍和促进因素。在目标3中，我们 通过三个国家伙伴组织传播会议结论。 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医院和社区医院参与实现这一目标的战略 议程，并为执行这一议程召集重要伙伴。这些发现将对 通过指导未来的研究工作来改善医院护理和儿童健康结果， AHRQ优先人群因此，这项工作符合AHRQ的使命，即提供证据， 更安全、更优质的护理。

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.