Pediatric Respiratory Illness Measurement System (PRIMES) Implementation in Community Hospital Settings

儿科呼吸疾病测量系统 (PRIMES) 在社区医院的实施

• 批准号: 10491041
• 负责人: RITA MANGIONE-SMITH
• 金额: $ 71.19万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10491041
• 关键词: Accident and Emergency department; Acute; Adherence; Admission activity; Applications Grants; Assessment tool; Asthma; Attitude; Belief; Bronchiolitis; Caring; Characteristics; Child; Childhood; Communities; Community Hospitals; Consensus; Consolidated Framework for Implementation Research; Data; Diagnosis; Evaluation Research; Funding; Future; Geography; Goals; Hospitalization; Hospitalized Child; Hospitals; Incentives; Individual; Inpatients; Intervention; Knowledge; Length of Stay; Link; Measurement; Measures; Medical Records; Medicine; Monitor; National Heart, Lung, and Blood Institute; Outcome; Patients; Pediatric Hospitals; Performance; Population; Practice Guidelines; Process; Prospective Studies; Provider; Quality of Care; Specific qualifier value; Structure; System; Thoracic Radiography; Variant; Work; base; care costs; care outcomes; cost; implementation barriers; implementation science; implementation strategy; improved; influenza virus vaccine; innovation; provider factors; respiratory; tool

Acute respiratory illness is a major cause of hospitalizations in the pediatric population with over 75% of admissions occurring in community–based (non-children's) hospitals. Focusing inpatient quality improvement (QI) efforts on these conditions is likely to have a significant impact on outcomes. The Pediatric Respiratory Illness Measurement System-Short Version (PRIMES-SV) tool is an abbreviated version of the previously developed and validated PRIMES quality assessment tool. Using medical records data, PRIMES-SV generates quality scores for both asthma and bronchiolitis, two of the most common conditions diagnosed in children admitted to community hospitals. The overall goals of this study are to demonstrate the sensitivity of PRIMES-SV measures to quality improvement (QI) interventions in community hospital settings, and to better understand the contextual and provider-level factors associated with both the ability to improve performance and to sustain those improvements. The specific aims of the study are: Aim 1. To implement the PRIMES-SV tool in six geographically diverse community hospitals to a) examine the degree of variation in performance across the hospitals and b) identify implementation barriers to high performance using the Consolidated Framework for Implementation Research (CFIR); Aim 2.To a) conduct a QI collaborative and improve overall performance on a sub-set of PRIMES-SV measures among the six hospitals by targeting CFIR-linked barriers with aligned strategies, and b) assess whether improved performance is associated with decreased LOS and costs; and Aim 3. To a) assess whether observed performance improvements are sustained on the targeted PRIMES-SV measures and b) determine which CFIR factors are linked with sustainment. These aims will be accomplished by bringing together a diverse group of experts in the fields of QI evaluation research, implementation science, and pediatric community-based hospital medicine. If using the proposed approach to QI is successful and improvements are sustained, the PRIMES-SV quality assessment tool used in combination with CFIR barrier-strategy matching could be widely disseminated to both community and children's hospitals to facilitate quality improvement for these common and high cost pediatric conditions.

急性呼吸道疾病是儿科人群住院的主要原因，75%以上的儿童 在以社区为基础的(非儿童)医院入院。着力提高住院病人质量 在这些条件下所做的努力可能会对结果产生重大影响。儿科呼吸系统 疾病测量系统-简写版本(PRIMES-SV)工具是以前 开发并验证PRIMES质量评估工具。使用医疗记录数据，PRIMES-SV 为哮喘和毛细支气管炎生成质量分数，这是在 儿童被送往社区医院。这项研究的总体目标是证明 PRIMES-SV对社区医院环境中的质量改进(QI)干预措施，以及更好的 了解与提高性能的能力相关的背景因素和提供商级别的因素 并维持这些进步。 研究的具体目标是：目标1.在六个地理位置不同的地区实施PRIMES-SV工具 社区医院：a)检查各医院绩效的差异程度；b)确定 使用实施研究综合框架实现高性能的实施障碍 (CFIR)；目标2)在PRIMES-SV子集上进行QI协作并提高整体绩效 在六家医院之间采取措施，目标是与CFIR相关的障碍，并制定一致的战略，以及b)评估 改进的性能是否与降低的损失和成本相关；以及目标3)评估 观察到的绩效改进在目标PRIMES-SV措施上持续存在，并且b)确定 哪些CFIR因素与可持续发展有关。 这些目标将通过聚集QI领域的不同专家小组来实现 评价研究、实施科学和儿科社区医院医学。如果使用 提出的QI方法是成功的，并且持续改进，PRIMES-SV质量评估 结合CFIR障碍-策略匹配使用的工具可以广泛传播到这两个社区 和儿童医院，以促进改善这些常见和高成本的儿科疾病的质量。