Effect of Paramedic Airway Experience on Patient Outcomes

这是NHLBI R21创新研究资助计划的一项建议，该计划鼓励对 现有的数据集，以探索新的假设。 气管内插管(ETI)是将塑料管插入气管(喉咙)以帮助呼吸。 患有严重疾病的患者，如心肺骤停、心力衰竭、呼吸衰竭或 精神创伤。虽然ETI是由医院的医生进行的，但复苏通常始于院外 在护理人员的护理下，医院环境。在临床实践的许多领域，医疗差错都是众所周知的 既与从业者的程序量有关，也与患者的预后有关。许多研究发现 医护人员在进行ETI时会出错。此外，在初步研究中，我们发现 护理人员在临床实践中很少进行ETI，而且频率远远低于维持ETI所需的频率 程序熟练、安全和有效。程序、成功和成功之间几乎没有直接联系 存在错误和患者结果(包括医院病程或资源利用)。我们假设ETI 由缺乏操作经验的护理人员执行可能会对患者预后和医院造成不利影响 护理过程。 这项研究的目标是确定护理人员(ETI)的程序经验是否与患者相关 结果和住院治疗过程。在拟议的研究中，我们将概率地将三个公开联系起来- 全州范围内现有的管理数据库，包括护理病人的会诊，已入院 住院病人和死亡人数。我们将对关联数据集应用多变量回归，以评估 辅助医疗ETI程序经验(每年ETI量)、结果(死亡率和 院内不良事件)和院内资源利用。 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， 在院外护理、卫生服务研究、大规模数据分析等领域拥有专业知识 集合和概率链接。这些发现可能会直接证明护理人员的ETI经历 影响患者的预后，并可能推动这一救生计划的设计和交付方面的重大变化- 院内干预。这些发现也将证实这种链接方法是一种新的、强大的工具 评估在院外环境中开始的急性医疗护理的最早部分。

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-savingout- 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 inthe out-of-hospital setting.