Comparative Effectiveness of Prehospital and Hospital Emergency Care

院前和院内急救护理的效果比较

• 批准号: 8059898
• 负责人: Derek DeLia
• 金额: $ 139.79万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8059898
• 关键词: Comparative; Effectiveness; Prehospital; Hospital; Emergency

DESCRIPTION (provided by applicant): Patients with critical conditions such as cardiac arrest or major trauma often depend on prehospital emergency medical services (EMS) for life-saving care. Nevertheless, the evidence base for that care, particularly as it relates to transitions between prehospital and hospital settings, is extremely limited. These transitions are poorly understood because data linking prehospital and hospital services are lacking. Without linked data, many important questions about the effectiveness of emergency care systems and protocols cannot be answered. This project will create a data infrastructure for comparative effectiveness research (CER) that bridges prehospital and hospital care using newly available electronic patient care records for prehospital EMS transports in New Jersey (Specific Aim 1). These data will be linked to all-payer hospital discharge abstract data and death certificates to support a wide range of comparative effectiveness studies on patient- and system-level interventions where prehospital and hospital services are tightly connected. The linkage draws on an innovative partnership between academic researchers and the New Jersey Department of Health and Senior Services (DHSS) which has access to confidential patient identifiers. The data infrastructure will be applied to a comparative effectiveness study of clinical outcomes after provision of therapeutic hypothermia (TH) for initial survivors of out-of-hospital cardiac arrest (Specific Aim 2). Out-of-hospital cardiac arrest (OHCA) is a major public health challenge, afflicting over 295,000 US residents annually. Two small randomized clinical trials demonstrated that therapeutic hypothermia can improve neurologically intact survival among patients with restored spontaneous circulation following OHCA. Nevertheless, despite the promulgation of national guidelines for use of hypothermia treatment, there have been no large-scale studies comparing this treatment to usual normothermic post-arrest care. The study will compare rates of neurologically intact survival at discharge and at 30 days between OHCA patients receiving and not receiving TH. Multivariate models will be used to adjust for confounders such as patient risk factors, EMS response times, and prehospital procedures performed. Differences in in-hospital complications (e.g., seizures, arrhythmias, shock) and resource use (overall length of stay and days in the ICU) will also be compared. Finally, access to this technology will be assessed among AHRQ priority populations. This project is innovative in creating one of the largest linked prehospital/hospital data sets in the U.S. and in conducting one of the first large-scale CER studies of TH. The linked database will enable a much wider scope of research and surveillance than is currently possible with narrowly defined trauma and cardiac event registries. The project draws on the expertise of a diverse team of senior experts in health services research, health policy, emergency medicine, and EMS operations. PUBLIC HEALTH RELEVANCE: Patients with critical conditions such as cardiac arrest or major trauma often depend on prehospital emergency medical services for life-saving care, but the evidence base for that care is extremely limited. This project will create a statewide data infrastructure in NJ for comparative effectiveness research linking prehospital to hospital data. A study of therapeutic hypothermia care for initial survivors of out-of-hospital cardiac arrest will demonstrate the value of this data infrastructure.

描述(由申请人提供)：患有心脏骤停或严重创伤等危重情况的患者通常依靠院前紧急医疗服务(EMS)进行救生护理。然而，这种护理的证据基础，特别是与院前和医院环境之间的过渡有关的证据基础极其有限。人们对这些转变知之甚少，因为缺乏将院前服务和医院服务联系起来的数据。如果没有相关数据，许多关于紧急护理系统和方案有效性的重要问题都无法得到回答。该项目将为比较有效性研究(CER)创建一个数据基础设施，利用新泽西州新获得的院前EMS运输的电子患者护理记录(具体目标1)，将院前护理和医院护理联系起来。这些数据将与所有付款人的医院出院摘要数据和死亡证明联系起来，以支持关于院前和医院服务紧密联系的患者和系统层面干预措施的广泛比较有效性研究。这种联系利用了学术研究人员和新泽西州卫生和高级服务部(DHSS)之间的创新合作伙伴关系，新泽西州卫生和高级服务部可以获得机密的患者身份。数据基础设施将用于对为院外心脏骤停(特定目标2)的最初幸存者提供治疗性低温(TH)后的临床结果的比较有效性研究。院外心脏骤停是一项重大的公共卫生挑战，每年困扰着超过29.5万名美国居民。两个小型随机临床试验表明，治疗性低温可以改善在肝细胞癌术后恢复自主循环的患者的神经功能完整存活率。然而，尽管颁布了使用低温治疗的国家指南，但还没有大规模的研究将这种治疗与通常的常温术后护理进行比较。这项研究将比较接受和不接受TH治疗的患者出院时和30天内神经功能完好的存活率。多变量模型将被用来调整混杂因素，如患者风险因素、EMS反应时间和执行的院前操作。还将比较住院并发症(例如癫痫、心律失常、休克)和资源使用(总住院时间和ICU天数)的差异。最后，将评估AHRQ优先人群对这项技术的使用情况。该项目在创建美国最大的关联院前/医院数据集以及进行TH的首批大规模CER研究方面具有创新性。与目前定义狭窄的创伤和心脏事件登记相比，链接的数据库将使研究和监测的范围更广。该项目利用了卫生服务研究、卫生政策、紧急医学和EMS操作方面的不同高级专家组成的不同团队的专业知识。 公共卫生相关性：患有心脏骤停或严重创伤等危重状况的患者通常依靠院前紧急医疗服务进行救生护理，但这种护理的证据基础极其有限。该项目将在新泽西州创建一个全州范围的数据基础设施，用于比较有效性研究，将院前数据与医院数据联系起来。一项对院外心脏骤停最初幸存者的治疗性低温护理的研究将证明这一数据基础设施的价值。

项目成果

Prehospital transportation to therapeutic hypothermia centers and survival from out-of-hospital cardiac arrest.

院前转运至低温治疗中心以及院外心脏骤停的存活率。

• DOI: 10.1186/s12913-015-1199-z
• 发表时间: 2015
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: DeLia,Derek;Wang,HenryE;Kutzin,Jared;Merlin,Mark;Nova,Jose;Lloyd,Kristen;Cantor,JoelC
• 通讯作者: Cantor,JoelC