The Role of Neighborhood- and Facility-Level Factors in Pediatric Sepsis Mortality

项目摘要/摘要 儿童败血症每年影响超过50,000名美国儿童，导致长期的功能残疾和 更高的死亡风险，代价近20亿美元。小儿脓毒症的早期识别和复苏 降低死亡率和改善结果。然而，目前对早期复苏指南的遵守仍然 在儿童败血症和感染性休克患者中较低。遵守儿科败血症护理指南的情况更差 在成人败血症人群中，特别是在低容量设施中。与成人相比，儿童脓毒症 如果较少获得明确的儿科治疗，患者可能面临不同发病率和结果的更高风险 医院护理。这项研究的中心假设是，儿童脓毒症死亡率的增加可以部分地 归因于具有相似严重程度的患者的地理访问和设施水平特征 生病了。这项研究将使用多个州的所有付款人的行政索赔数据和 急诊科(ED)验证中心假设的目的如下：(1)确定设施级别 与有效的儿科败血症护理相关的特征和(2)确定获得护理在以下方面的作用 儿科败血症的结局。拟议的工作将为了解这一进展提供证据基础 为获得机会减少的儿科人群提供儿科脓毒症质量改进方案和系统 送到儿童医院。该研究培训项目将为摩根·斯旺森(首席调查员)配备 研究经验、高级批判性思维技能和技术知识 独立调查员。作为一名未来的内科科学家，这个项目将为斯旺森女士提供 发展专注于将儿科危重疾病负担降至最低的研究生涯的基本技能 通过改善紧急保健服务的获得和提供。

PROJECT SUMMARY/ABSTRACT Pediatric sepsis affects over 50,000 U.S. children each year, resulting in long-term functional disability and higher risk of mortality at a cost of nearly $2 billion. Early recognition and resuscitation of pediatric sepsis can reduce mortality and improve outcomes. However, current adherence to early resuscitation guidelines remains low among pediatric sepsis and septic shock patients. Adherence to pediatric sepsis care guidelines is worse than in the adult sepsis population, especially in low-volume facilities. Compared to adults, pediatric sepsis patients may be at higher risk of disparate incidence and outcomes given sparser access to definitive pediatric hospital care. The central hypothesis of this study is that increased pediatric sepsis mortality can be partially attributed to geographic access and facility-level characteristics among patients with similar severities of illness. This study will use multi-state all-payer administrative claims data and a national readiness survey of emergency departments (EDs) to test the central hypothesis with the following aims: (1) identify facility-level characteristics associated with effective pediatric sepsis care and (2) determine the role of access to care in pediatric sepsis outcomes. The proposed work will provide a foundation of evidence to inform the development of pediatric sepsis quality improvement programs and systems for pediatric populations with decreased access to children’s hospitals. This research training project will equip Morgan Swanson (Principal Investigator) with the research experience, advanced critical thinking skills, and technical knowledge to succeed as an independent investigator. As a future physician-scientist, this project will provide Ms. Swanson with foundational skills to develop a research career focused on minimizing the burden of pediatric critical illness through improving emergency health care access and delivery.