Factors Associated with Quality of Care Delivered to Children in US EDs

描述(由申请人提供)：该项目的总体目标是进一步验证一种可用于衡量和改善急诊科(ED)儿童护理质量的护理质量工具。为了帮助实现这一目标，我们将通过一个大型儿科急诊研究网络-儿科急救应用研究网络(PECARN)与国家专家合作。基于专家医生评审的护理质量量表将应用于在12个不同类别的PECARN医院急诊室接受治疗的600名儿童的样本。使用这一工具，我们希望确定不同环境下的护理质量差异，包括不同类型的急诊医生、不同培训的医生，以及几个患者因素，包括性别、患者种族/民族和付款人来源。一旦确定了这些因素，就可以确定最佳做法并提出政策建议，以提高向全国各地急诊室提供的儿童的护理质量。目标和目标：我们的长期目标是创建一种通用的护理质量工具，用于改善在急诊室为儿童提供的护理质量。短期目标是重新评估结构化隐性回顾工具的一致性、可靠性和结构效度，该工具衡量向急诊室提供的儿童的护理质量，并确定与美国各地向急症和受伤儿童提供的急诊室护理质量差异相关的可修改因素(医院、急诊室、医生、患者和呈现因素)。研究设计：拟议的研究将是一项对600名儿童的回顾性横断面研究，他们在PECARN中向12个选定的急诊室提供护理。每一份不确定的病历将由从8名审查员中随机挑选的4名内科专家审查员进行审查。为了验证该仪器，我们将把我们的结果与根据循证指南和专家共识(Gausche-Hill仪器)制定的针对哮喘、发热性癫痫、胃肠炎和头部创伤患者的客观测量进行比较。我们还将通过比较基于处置的适当性的小组(使用REPEAT和PRISA II)以及与其他评价者的交叉验证来验证该工具。然后，我们将使用标准的多变量回归方法和多水平建模来检查与护理质量相关的几个医院、急诊室、医生、患者和表现因素。结论：我们的发现和这项研究中建立的隐性审查护理质量工具将帮助研究人员、提供者和医疗政策制定者识别最佳实践，并提出建议、标准和政策，旨在解决护理方面的差异，以提高向全国各地急诊室提供的儿童的护理质量。 公共卫生相关性：我们建议的研究将验证结构化的隐性质量工具，这项研究的结果可以被医疗保健学者、研究人员、提供者和政策制定者用来制定质量基准、标准和政策的建议，旨在提高向全国各地急诊室提供的儿童的护理质量

DESCRIPTION (provided by applicant): The overall goal of this project is to further validate a quality of care instrument which can be used to measure and improve the quality of care delivered to children in emergency departments (ED). To help achieve this goal, we will collaborate with national experts across a large Pediatric ED research network, the Pediatric Emergency Care Applied Research Network (PECARN). The quality of care instrument, based on expert physician review, will be applied to a sample of 600 children treated in 12 heterogeneous PECARN hospital EDs. With this instrument, we expect to identify differences in quality of care across different settings including different types of EDs, differently trained physicians, and several patient factors, including gender, patient race/ethnicity, and payer source. Once these factors are identified, best practices can be identified and policy recommendations made to improve the quality of care delivered to children presenting to EDs across the country. Objective and Goals: Our long-term objective is to create a generalizable quality of care instrument that can be used to improve the quality of care provided to children in the ED. The short- term objective is to reassess the consistency, reliability and construct validity of a structured implicit review instrument that measures the quality of care provided to children presenting to EDs, and to identify modifiable factors (hospital, ED, physician, patient and presentation factors) associated with differences in quality of ED care delivered to acutely ill and injured children across the U.S. Study design: The proposed study will be a retrospective cross-sectional study of 600 children who present to 12 selected EDs in the PECARN. Each de-identified medical record will be reviewed by four physician expert reviewers randomly selected from a pool of 8 reviewers. To validate the instrument, we will compare our results to objective measures developed from evidence-based guidelines and expert consensus (Gausche-Hill Instrument) for patients treated for asthma, febrile seizure, gastroenteritis, and head trauma. We will also validate the instrument by comparing groups based on appropriateness of disposition (using Re-PEAT and PRISA II), and cross validation with other reviewers. We will then examine several hospitals, ED, physician, patient and presentation factors associated with quality of care using standard multivariable regression methods and multi-level modeling. Conclusion: Our findings and the implicit review quality of care instrument established in this study will help researchers, providers, and healthcare policy makers identify best practices and make recommendations, standards and policies aimed at addressing disparities in care to improve the quality of care delivered to children presenting to EDs across the country. PUBLIC HEALTH RELEVANCE: Our proposed study will validated a structured implicit quality instrument and results of this study could be used by healthcare academicians, researchers, providers, and policy makers in developing recommendations for quality benchmarks, standards and policies targeted at improving the quality of care delivered to children presenting to EDs across the country