Clinically enhanced multi-purpose administrative dataset for comparative effectiv

描述(由申请人提供)：比较有效性研究日益成为卫生保健研究、决策和质量改进过程中必不可少的工具。新颁布的保健改革确立了保健服务的新视角，强调和鼓励控制成本和有效利用资源。缺乏关键的成本效益比较信息来评估干预方案，从而使护理提供者、消费者、决策方以及其他利益攸关方能够对现有替代方案作出知情的决定和选择，这可能会阻碍实现新的医疗保健改革的潜在可累积效益。佛罗里达州的医疗体系非常昂贵，全球每年的医疗支出增长、个人医疗支出和人均医疗支出都超过了全国平均水平。在全州范围内，缺乏可靠且经过严格验证的大型临床强化管理数据库，这阻碍了公共卫生和其他研究人员提供循证数据的能力，这些数据可以为决策提供信息，并提高该州卫生保健资源的有效利用。正是出于这个原因，拨款提案中的项目是州的资本，因为它设想填补这一缺口，如果佛罗里达州要在新颁布的国家医疗改革下，在未来成功实现具有成本效益和效率的医疗保健提供系统，这是必要的一步。选择妇幼保健作为重点是及时和知情的，因为尽管支出巨大，但佛罗里达州在预防孕产妇死亡和早产方面的表现低于全国其他地区的平均水平。正是出于这些原因，我们提出了这项研究的以下具体目标：具体目标1：通过与其他数据源的链接增加目前全州的住院数据文件，为佛罗里达州创建一个扩大的临床增强的母婴数据集；具体目标2：通过建立公众对数据集的使用信心的严格程序，在具体目标1中验证创建的数据集；具体目标3：以早期选择性分娩为案例研究，展示新创建的丰富的数据集在进行比较有效性分析方面的效用。该项目的数据集将包含来自以下数据源的信息：出生证明、住院出院数据、门诊和急诊科数据、财务数据和佛罗里达州孕产妇死亡率数据。该项目的成功是有保证的，因为该项目是建立在现有的全州范围内的伙伴关系基础上的，该伙伴关系已经完成了较早前的一项数据链接活动，该活动产生了一个完善的数据集，该数据集将作为这次赠款拟议活动的主要模板。该项目对佛罗里达州很重要，因为它可能导致研究，提供必要的关键信息，使卫生保健利益相关者有效地促进最佳临床实践，并监测质量改进，总体目标是加强该州的母婴健康。 公共卫生相关性：这项研究的目的是创建一个可靠的大型全州数据库，其中包含临床和非临床信息，这些信息将有助于比较有效性研究，并将作为提高质量的工具，总体目标是增强总体人口健康。该项目新创建的数据集将包含来自以下数据源的信息：出生证明、住院出院数据、门诊和急诊科数据、财务数据和佛罗里达州孕产妇死亡率数据。拟议的项目享有强大的全州合作伙伴关系，一段时间以来一直在共同努力，以实现为这笔赠款规定的一些目标，因此，该提议成功的可能性非常高。

DESCRIPTION (provided by applicant): Comparative effectiveness research is increasingly becoming an essential tool in health care research, and decision-making, and quality improvement process. The newly enacted health care reform establishes a new perspective of health care services with emphasis and incentives for cost-containment and efficient utilization of resources. The paucity of critical comparative cost-effectiveness information to assess intervention options that will enable care providers, consumers, decision-making parties as well as other stakeholders to make informed decisions and choices on available alternatives could hamper the realization of the potentially accruable benefits of the new health care reform. The state of Florida suffers from a very costly health care system with global annual health care expenditure growth, personal health care and per capita health care expenditures that exceed the national average. The virtual absence of reliable and rigorously validated large, clinically enhanced administrative databases statewide hinders the ability of public health and other researchers to offer evidence-based data that could inform decision-making and improve efficient utilization of health care resources in the state. It is for this reason that the project in this grant proposal is capital for the state because it envisages filling this gap, which is a necessary step if Florida is to succeed in achieving a cost-effective and efficient health care delivery system in the future under the newly enacted national health care reform. The choice of maternal and child health as a focus is timely and well-informed because despite huge spending, Florida is performing below average compared to the rest of the nation in preventing maternal deaths and preterm births. It is for these reasons that we propose this study with the following specific aims: Specific Aim 1: To create an expanded clinically enhanced maternal-infant dataset for the State of Florida by augmenting the current statewide hospitalization data files through linkages to other data sources; Specific Aim 2: To validate the created dataset in Specific Aim 1 through a rigorous process that will establish confidence in the use of the dataset by the public; Specific Aim 3: To demonstrate the utility of the newly created enriched dataset in conducting comparative effectiveness analysis using early term elective delivery as a case study. The dataset from the project will encompass information from the following data sources: the birth certificate, in-patient hospital discharge data, ambulatory and emergency department data, financial data and Florida maternal mortality data. The success of the project is assured because the undertaking is based on an existing firm statewide partnership that has already completed an earlier data linkage activity that resulted in a refined dataset which will serve as the main template for the activities proposed for this grant. The project is important for Florida because it could lead to research that will provide critical information required to enable health care stakeholders effectively promote best clinical practices and to monitor quality improvement with the overall objective of enhancing maternal-infant health in the state. PUBLIC HEALTH RELEVANCE: The aim of this study is to create a reliable large statewide database that contains clinical and non-clinical information which will be useful for comparative effectiveness research and will serve as a tool for quality improvement with the overall objective of enhancing overall population health. The newly created dataset from the project will encompass information from the following data sources: the birth certificate, in-patient hospital discharge data, ambulatory and emergency department data, financial data and Florida maternal mortality data. The proposed project enjoys a strong statewide collaborative partnership that has been working together for sometime now to attain some of the objectives spelled out for this grant, and hence, the proposal has a very high probability of success.