Effect of Paramedic Airway Experience on Patient Outcomes

这是NHLBI R21创新研究资助计划的提案，该计划鼓励分析现有数据集以探索新的假设。气管插管（ETI）是将塑料管插入气管（喉咙），以帮助患有心肺骤停、心力衰竭、呼吸衰竭或重大创伤等危重疾病的患者呼吸。虽然ETI是由医生在医院里进行的，但复苏通常是在医院外护理人员的护理下开始的。在临床实践的许多领域中，已知医疗差错与从业者程序量以及患者结果两者相关联。许多研究发现，护理人员在执行ETI时会犯错误。此外，在一项初步研究中，我们发现护理人员在临床实践中很少进行ETI，频率远远低于维持手术熟练度、安全性和有效性所需的频率。手术、成功和错误与患者结局（包括医院病程或资源利用）之间几乎没有直接联系。我们认为，由缺乏手术经验的护理人员进行ETI可能会对患者结局和医院护理过程产生不利影响。本研究的目的是确定护理人员（ETI）手术经验是否与患者结局和住院护理过程相关。在拟议的研究中，我们将概率链接三个公开的全州范围内的行政数据库，包括护理人员的病人遭遇，住院病人和死亡。我们将对关联数据集应用多变量回归，以评价辅助ETI手术经验（ETI的年量）、结局（死亡率和院内不良事件）和院内资源利用之间的联系。我们建议匹兹堡大学和犹他州大学的研究团队之间进行新的合作，这两所大学在院外护理、卫生服务研究、大规模数据集分析和概率联系等领域拥有专业知识。这些发现可能表明，护理人员的ETI经验直接影响患者的结果，并可能促进这种挽救生命的院外干预的设计和实施的重大变化。这些发现也将证实这种联系方法作为一种新的，强大的工具，以评估最早的部分急性医疗护理-开始在医院外的设置。

DESCRIPTION (provided by applicant): This is a proposal for the NHLBI R21 Innovative Research Grant Program, which encourages the analysis of existing data sets to explore new hypotheses. Endotracheal intubation (ETI) is the insertion of a plastic tube into the trachea (throat) to assist the breathing of a patient with a critical illness such as cardiopulmonary arrest, heart failure, respiratory failure or major trauma. While ETI is performed by physicians in the hospital, resuscitation usually begins in the out-of- hospital setting under the care of paramedics. In many fields of clinical practice, medical errors are known to be associated with both practitioner procedural volume as well as patient outcome. Many studies have found that paramedics commit errors when performing ETI. Furthermore in a preliminary study, we found that paramedics perform ETI infrequently in clinical practice and at frequencies far below that needed to maintain procedural proficiency, safety and effectiveness. Few direct links between the procedure, success and errors, and patients outcomes (including hospital course or resource utilization) exist. We posit that ETI performed by paramedics with low procedural experience may adversely affect patient outcome and hospital course of care. The goal of this study is to determine if paramedic (ETI) procedural experience is associated with patient outcomes and in-hospital course of care. In the proposed study we will probabilistically link three publicly- available statewide administrative databases encompassing paramedic patient encounters, admitted inpatients and deaths. We will apply multivariable regression to the linked data set to evaluate the connection between paramedic ETI procedural experience (annual volume of ETI), outcomes (mortality and in-hospital adverse events) and in-hospital resource utilization. We propose a new collaboration between research teams at the Universities of Pittsburgh and Utah, which have expertise in the areas of out-of-hospital care, health services research, the analysis of large-scale data sets and probabilistic linkage. These findings may demonstrate that paramedic ETI experience directly impacts patient outcome, and may promote major changes in the design and delivery of this life-saving out- of-hospital intervention. These findings would also confirm this linkage method as a new, powerful tool to evaluate the earliest portion of acute medical care - that begun in the out-of-hospital setting.