A Critical Assessment of and Opportunities for Improvement in the Interhospital Transfer of Emergency General Surgery patients

项目摘要/摘要 急诊普外科(EGS)指的是对急性、非创伤性疾病患者的护理，这些疾病可能 需要动手术，如憩室炎。近五分之一的EGS患者是从急诊转来的 科室被送到另一家医院治疗。在调整了疾病的严重程度后，转移的EGS患者 与直接入院的患者相比，其发病率和死亡率更高。然而，不存在有组织的系统 为这些转移提供便利，并有可能改善结果。优化医院之间的转运需要 全面、快速的组织间协调。协调方面的循证改进 医院和康复机构之间的护理改善了结果，并有可能受益 EGS患者在急诊医院之间转院。关系协调是一个既定的概念 研究组织间协调的模型；然而，它还没有被应用于EGS转移 并可能产生重要的干预措施，以改善患者的预后。 该项目提出了以下目标：1)绘制当前医院间EGS转送系统 威斯康星州(威斯康星州)了解网络结构和“联系强度”之间的关联(即， 共享患者的数量)和患者结果；2)探讨 转介和接受参与医院间EGS转送的提供者，以更好地了解它们的影响 协调护理；3)让关键利益攸关方参与全州范围的协作努力，以确定目标和 设计干预措施以改善医院间EGS转送。通过有指导的研究和职业生涯 发展经验，英格拉汉姆博士将为领导健康服务研究(HSR)的职业生涯做准备 研究护理质量、实践模式和政策评估的计划。她将在1)年内获得专业知识 定量网络分析；2)定性研究方法；3)通过 外科协作；4)利益相关者参与；5)负责任的研究行为。 作为一名拥有临床调查硕士学位的急诊普通外科医生，英格拉汉姆医生是独一无二的 有资格做这项工作。这项建议填补了教育和职业发展方面的差距，这对确保 通过多学科指导计划与网络分析、定性和定量方面的专家进行独立资助 研究、护理过渡和关系协调。她得到了强有力的研究的支持 威斯康星大学的基础设施，那里的外科系在国家研究院中排名第六 健康基金和WI手术结果研究计划促进合作和成功 卫生服务研究人员。该奖项满足了迫切的公共卫生需求，同时提供了教育和 有指导的研究经验对英格拉汉姆博士领导独立研究项目至关重要。

PROJECT SUMMARY/ABSTRACT Emergency general surgery (EGS) refers to the care of patients with acute, non-traumatic illnesses that may require surgery, such as diverticulitis. Nearly one in five EGS patients is transferred from an emergency department to another hospital for their care. After adjusting for severity of illness, transferred EGS patients experience higher morbidity and mortality than directly admitted patients. However, no organized system exists to facilitate these transfers and potentially improve outcomes. Optimized transfers between hospitals require comprehensive and rapid interorganizational coordination. Evidence-based improvements in the coordination of care between hospitals and rehabilitation facilities have improved outcomes and have the potential to benefit EGS patients transferred between acute care hospitals. Relational Coordination is an established conceptual model to study interorganizational coordination; however, it has not yet been applied to the EGS transfer network and may yield important interventions for improvement in patient outcomes. This project proposes the following aims: 1) Map the current system of interhospital EGS transfers in Wisconsin (WI) to understand the network structure and the association between the “strength of ties” (i.e., number of shared patients) and patient outcomes; 2) Explore the relationships and communication between referring and accepting providers involved in interhospital EGS transfers to better understand how they impact coordination of care; 3) Engage key stakeholders in a statewide collaborative effort to prioritize targets and design an intervention to improve interhospital EGS transfers. Through a mentored research and career development experience, Dr. Ingraham will prepare for a career leading a health services research (HSR) program to study quality of care, practice patterns, and policy evaluation. She will acquire expertise in 1) quantitative network analysis; 2) qualitative research methods; 3) the study of healthcare systems through surgical collaboratives; 4) stakeholder engagement; and 5) responsible conduct of research. As an emergency general surgeon with a master's degree in Clinical Investigation, Dr. Ingraham is uniquely qualified for this work. This proposal fills educational and career development gaps critical to securing independent funding through a multidisciplinary mentored program with experts in network analysis, qualitative research, transitions of care, and Relational Coordination. She is supported by the robust research infrastructure at the University of Wisconsin, where the department of surgery ranks sixth in National Institutes of Health funding and the WI Surgical Outcomes Research Program promotes the collaboration and success of health services researchers. This award meets an urgent public health need while affording the education and mentored research experience critical for Dr. Ingraham to lead an independent research program.