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

项目总结/摘要 儿科败血症每年影响超过50，000名美国儿童，导致长期功能障碍， 更高的死亡风险，成本近20亿美元。小儿败血症的早期识别和复苏， 降低死亡率并改善预后。然而，目前对早期复苏指南的坚持仍然存在， 在儿科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糟 在成人败血症人群中，尤其是在低容量设施中。与成人相比， 由于缺乏明确的儿科治疗， 医院护理。本研究的中心假设是，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位置和设施水平特征， 病这项研究将使用多个州的所有付款人行政索赔数据和全国准备调查， 急诊科（ED），以检验中心假设，其目的如下：（1）确定设施级 与有效的儿科脓毒症护理相关的特征和（2）确定获得护理在 儿科败血症结局。拟议的工作将提供一个证据的基础，以告知发展 儿科脓毒症质量改进计划和系统的儿科人群减少访问 儿童医院。本研究培训项目将使Morgan Swanson（首席研究员） 研究经验，先进的批判性思维能力和技术知识，以成功地作为一个 独立调查员作为一名未来的医学科学家，这个项目将为斯旺森女士提供 发展研究事业的基础技能，重点是最大限度地减少儿科危重疾病的负担 通过改善紧急医疗服务的获取和提供。

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.