The structure and outcomes of critical care transfer network

重症监护转移网络的结构和结果

• 批准号: 7871348
• 负责人: Theodore J Iwashyna
• 金额: $ 13.22万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-19 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7871348
• 关键词: Acute; Acute myocardial infarction; American; Biological Models; Cardiac; Caring; Cessation of life; Characteristics; Critical Care; Critical Illness; Data; Disease; Foundations; Goals; Grant; Habits; Hospitals; Incentives; Intervention; Lung; Maps; Measures; Mechanical ventilation; Medical; Medicare claim; Medicine; Methods; Modeling; Operative Surgical Procedures; Outcome; Pathway Analysis; Patient Care; Patient Transfer; Patients; Pattern; Policies; Positioning Attribute; Process; Provider; Quality of Care; Research; Research Personnel; Resources; Risk; Science; Sorting - Cell Movement; Specific qualifier value; Structure; System; Testing; United States; Variant; abstracting; density; improved; interest; mortality; novel; programs

DESCRIPTION (provided by applicant): The care "of critically ill patients is a common, expensive, and growing part of American medicine. Some hospitals provide higher quality care to these patients than do other hospitals. Every year approximately 10,000 patients die from acute myocardial infarction who might have been saved had they been at a higher performing hospital. Similarly large numbers of patients die potentially avoidable deaths after mechanical ventilation. Given these large variations between hospitals in the quality of their care, there is growing interest in developing a formal system to transfer patients to higher quality hospitals. While there are calls for a formal system for transferring patients, an unplanned system has already evolved for the transfer of critically ill patients. We know critical care transfers are common, but we know very little abput the network over which they are transferred. In particular, we do not know whether the network directs patients towards higher quality hospitals. The global hypothesis of this proposal is that the critical care transfer network is a coherent structure, not just an aggregation of random processes. This structure, we hypothesize, is directly related to hospital organizational characteristics, impacts patient outcomes, and is amenable to intervention. We will perform three Specific Aims. First, we will map and characterize the network structure. Second, we will examine the association between a hospital's centrality in the network - that is, the degree to which the network moves patients towards to the hospital - and hospital organizational characteristics and capabilities. Third, we will determine the relationship between a hospital's network centrality and outcomes of its patients: We will use as our model system 30-day mortality after one of the most common disease processes requiring critical care: acute myocardial infarction. Data for this project will be derived primarily from the Medicare claims. This research is directly relevant to the goal of providing high quality care to patients with acute illness, particularly acute cardiac and pulmonary derangements. This proposal investigates whether the existing network of critical care transfers can be used as a foundation to improve the care of patients by moving patients to hospitals that provide better care. (End of Abstract)

描述（由申请人提供）： 对危重病人的护理是美国医学中一个常见的、昂贵的、不断增长的部分。一些医院为这些患者提供比其他医院更高质量的护理。每年约有10，000名患者死于急性心肌梗死，如果他们在性能更好的医院，他们可能会被挽救。同样，大量患者在机械通气后死亡，这是可能避免的。鉴于医院之间的护理质量存在很大差异，人们越来越有兴趣开发一个正式的系统，将患者转移到更高质量的医院。虽然有人呼吁建立一个正式的病人转移系统，但一个计划外的系统已经发展成为危重病人的转移系统。我们知道重症监护转移很常见，但我们对转移网络知之甚少。特别是，我们不知道该网络是否将患者引向更高质量的医院。该建议的总体假设是，重症监护转移网络是一个连贯的结构，而不仅仅是随机过程的集合。这种结构，我们假设，是直接相关的医院组织特征，影响病人的结果，并适合干预。我们将实现三个具体目标。首先，我们将映射和描述网络结构。其次，我们将研究医院在网络中的中心地位（即网络将患者转移到医院的程度）与医院组织特征和能力之间的关联。第三，我们将确定医院的网络中心性与患者结局之间的关系：我们将使用急性心肌梗死作为模型系统，该疾病是最常见的需要重症监护的疾病之一。该项目的数据将主要来自医疗保险索赔。这项研究直接关系到为急性疾病患者提供高质量护理的目标，特别是急性心脏和肺疾病。该提案调查了现有的重症监护转移网络是否可以作为基础，通过将患者转移到提供更好护理的医院来改善患者的护理。(End摘要）