Improving Evidence-Based Quality of Care in Acute Stroke

应聘者描述(申请人提供)：应聘者的长期职业目标是在中风研究领域发展一个独立的职业生涯，重点关注护理质量、中风护理对患者结局的影响以及改善循证护理交付的方法。为了实现这些目标，应聘者制定了一项为期五年的职业发展计划，其中包括卫生服务研究(成果集中)的正式学位和以下有指导的研究项目。美国的中风死亡率在20世纪70年代和80年代迅速下降。然而，尽管在20世纪90年代中风治疗方面取得了许多进展，但这种下降已经放缓。这项拟议的研究将重点放在证据-实践差距上，以此来解释尽管中风治疗取得了进步，但中风死亡率却趋于平缓。我们将使用明尼阿波利斯-圣彼得堡汇编的基于人口的数据集。保罗地区医院由明尼苏达州改善中风护理管理项目资助，这是一项由AHRQ资助的临床试验，旨在检查急性缺血性中风护理的质量。该数据库将通过死亡率数据和由医疗保险和医疗补助服务中心汇编的医疗保险文件进行扩充。拟议的赠款将使用这些数据来实现以下目标：1)描述急性缺血性中风住院患者的全面预后概况；2)根据所接受的护理来模拟急性缺血性中风的结局；3)确定患者、临床医生和医院对中风护理质量的决定因素。此外，我们将在一家医院开发和试行旨在改善循证护理质量指标遵从性的干预措施。这项试点研究将形成R01赠款的基础，旨在审查改善社区医院提供循证中风护理的干预措施。与公共健康相关：我们的工作利用了基于人群的数据集，因此我们关于中风结果的结果将描述中风患者群体中疾病的自然病史。我们关于护理质量决定因素的结果对公共卫生有许多影响，因为它将告诉我们以质量改进倡议为目标的适当领域。我们预计，我们的初步研究最终将扩大到一项涉及社区医院的更大规模的研究。

DESCRIPTION (provided by applicant): The candidate's long term professional goals are to develop an independent career in stroke research with a focus on quality of care, the impact of stroke care on patient outcomes and methods for improving the delivery of evidence-based care. To achieve these goals the candidate has developed a five-year career development plan involving a formal degree in Health Services Research (Outcomes Concentration) and the following mentored research project. Stroke mortality in the United States has declined rapidly in the 1970s and 1980s. However, this decline has slowed despite numerous advances in stroke treatments in the 1990s. The proposed research focuses on the evidence-practice gap as an explanation for the flattening of stroke mortality despite treatment advances in stroke care. We will use a population-based data set compiled in the Minneapolis-St. Paul area hospitals by the Project to Improve Stroke Care Management in Minnesota, an AHRQ funded clinical trial designed to examine the quality of acute ischemic stroke care. This database will be augmented by mortality data and by Medicare files compiled by the Center for Medicare and Medicaid Services. The proposed grant will use these data to accomplish the following aims: 1) Describe a comprehensive profile of outcomes in a population of patients hospitalized with acute ischemic stroke, 2) Model acute ischemic stroke outcomes in terms of care received, 3) Identify patient, clinician and hospital determinants of quality of stroke care. In addition, we will develop and pilot test an intervention designed to improve compliance with evidence-based quality of care indicators at one hospital. This pilot study will form the basis for a R01 grant designed to examine interventions for improving the delivery of evidence-based stroke care in community hospitals. Relevance to public health: Our work utilizes a population-based data set and hence our results on stroke outcomes will describe the natural history of the disease in a population of stroke patients. Our results on the determinants of quality of care have numerous public health implications since it will inform us as to the appropriate areas to target quality improvement initiatives. We anticipate that our pilot study will eventually be scaled to a larger study involving community hospitals.