PHYSIOLOGIC SEVERITY INDEX FOR NEONATAL INTENSIVE CARE

新生儿重症监护的生理严重程度指数

• 批准号: 3371726
• 负责人: DOUGLAS K RICHARDSON
• 金额: $ 22.71万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1991
• 资助国家: 美国
• 起止时间: 1991-07-01 至 1993-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3371726
• 关键词: disease /disorder proneness /risk; health care cost /financing; health care service evaluation; hospital length of stay; hospital utilization; human morbidity; human mortality; medical complication; neonatal intensive care; newborn human (0-6 weeks); physiology; premature infant human; prognosis

In the 01 and 02 years of this grant (March 1989-February 1991), we have been developing a physiology-based severity of illness score for newborn intensive care, the Score for Neonatal Acute Physiology (SNAP). This proposal describes an extension of that work already in progress. During the first 1-1/2 years of this 2-year grant, we have completed 60% of data collection and performed preliminary analyses. These analyses provide evidence that such a score is practical and that it appears to correlate well with mortality, and other markers of severity including therapeutic intensity, nursing acuity and physician and nurse judgment scales. Most importantly, measured severity is virtually independent of birthweight and therefore represents a new dimension for investigating outcomes. Extensive refinement and rigorous evaluation of validity and scaling characteristics will be completed by March 1991. As part of the review process, score development was considered a higher priority than correlation with costs. Moreover, further developmental work was needed to obtain cost data. With the preliminary analyses confirming the potential utility of the score, the extensive clinical database of neonatal ICU admissions and the availability of further information on costs, we are now requesting support to analyze a number of important issues relating to severity of illness and NICU resource consumption. The importance of this request lies in the fact that, while there is extensive literature on adult and pediatric ICU utilization and costs, very little is available on the unique characteristics of costs, utilization, and severity of illness in NICU care. We propose to apply a number of the analytic approaches from the adult and pediatric ICU studies to NICUs, specifically: (1) the determinants of NICU admission for other than extreme prematurity, including the whole process of NICU triage which is heretofore undescribed; (2) the determinants of NICU discharge, including the role of severity and availability of step-down facilities; and (3) the determinants of ancillary use according to severity, birthweight, and diagnosis. These analyses are feasible without further primary data collection, and require only the acquisition of hospital financial tapes and one tape from a state agency. The ready availability of the data, high costs of NICU care and paucity of existing literature all suggest the value of these studies.

在01年和02年的赠款（1989年3月至1991年2月），我们有 一直在为新生儿开发一种基于生理学的疾病严重程度评分， 新生儿急性生理学评分（SNAP）。 这 该提案描述了已经在进行的工作的扩展。 期间 在两年资助的前一年半，我们完成了60%的数据 收集并进行初步分析。 这些分析提供 证据表明，这样的分数是实际的，它似乎与 死亡率以及其他严重程度的标志物，包括治疗性 强度，护理敏锐度和医生和护士的判断量表。 最 重要的是，测量的严重程度实际上与出生体重无关， 因此，这是调查结果的一个新层面。 广泛 有效性和缩放特性的细化和严格评估 将于一九九一年三月完成。 作为审查过程的一部分，分数发展被认为是更高的 优先级高于成本相关性。 此外，进一步的发展工作 需要获得成本数据。 初步分析证实 评分的潜在效用，广泛的临床数据库， 新生儿重症监护室入院和进一步信息的可用性 我们现在请求支持，以分析一些重要的 与疾病严重程度和NICU资源消耗有关的问题。 这一请求的重要性在于，虽然有 关于成人和儿科ICU利用率和成本的大量文献， 关于成本，利用率， 和NICU护理中的疾病严重程度。 我们建议采用一些 从成人和儿科ICU研究到NICU的分析方法， 具体而言：（1）NICU入院的决定因素， 极端早产，包括NICU分诊的整个过程， （2）NICU出院的决定因素，包括 严重程度的作用和降压设施的可用性;以及（3） 根据严重程度、出生体重和 诊断. 这些分析是可行的，无需进一步收集原始数据， 只需要购买医院财务磁带和一个磁带从 一个国家机构 数据的现成可用性，NICU的高成本 现有文献的关心和缺乏都表明了这些的价值 问题研究