Improving Evidence-Based Quality of Care in Acute Stroke

描述（由申请人提供）：候选人的长期职业目标是在卒中研究中发展独立的职业生涯，重点关注护理质量，卒中护理对患者结局的影响以及改善循证护理的方法。为了实现这些目标，候选人已经制定了一个五年的职业发展计划，涉及卫生服务研究（成果浓度）和以下指导研究项目的正式学位。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20世纪90年代中风治疗取得了许多进展，但这种下降已经放缓。拟议的研究集中在证据-实践差距作为中风死亡率平坦的解释，尽管在中风护理治疗的进步。我们将使用明尼苏达州改善卒中护理管理项目在明尼阿波利斯-圣保罗地区医院编制的基于人群的数据集，该项目是AHRQ资助的临床试验，旨在检查急性缺血性卒中护理的质量。该数据库将通过死亡率数据和医疗保险和医疗补助服务中心编制的医疗保险文件进行扩充。拟议的补助金将使用这些数据来实现以下目标：1）描述急性缺血性卒中住院患者的综合结局概况，2）根据接受的护理建立急性缺血性卒中结局模型，3）确定卒中护理质量的患者，临床医生和医院决定因素。此外，我们还将在一家医院开发和试点测试一种干预措施，旨在提高对循证护理质量指标的依从性。这项试点研究将成为R 01赠款的基础，该赠款旨在研究改善社区医院循证中风护理的干预措施。与公共卫生的相关性：我们的工作利用了一个基于人群的数据集，因此我们关于中风结局的结果将描述中风患者人群中疾病的自然史。我们的结果对医疗质量的决定因素有许多公共卫生的影响，因为它会告诉我们，以适当的领域，以提高质量的举措。我们预计，我们的试点研究最终将扩大到一个更大的研究，涉及社区医院。

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.