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

描述（由申请人提供）：本项目的总体目标是进一步验证护理质量工具，该工具可用于测量和提高急诊科（艾德）儿童护理质量。为了帮助实现这一目标，我们将在一个大型儿科艾德研究网络，儿科急诊应用研究网络（PECARN）的国家专家合作。基于专家医师审查的护理质量工具将应用于在12家异质性PECARN医院急诊室接受治疗的600名儿童样本。通过该工具，我们希望识别不同环境中的护理质量差异，包括不同类型的ED，不同培训的医生和几个患者因素，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，以提高全国各地向急诊科就诊的儿童提供的护理质量。宗旨和目标：我们的长期目标是创建一个可推广的护理质量工具，可用于改善为ED儿童提供的护理质量。短期目标是重新评估结构化隐式评估工具的一致性，可靠性和结构效度，该工具用于测量为ED儿童提供的护理质量，并确定可修改的因素（医院，艾德，医生，病人和介绍因素）与美国急性病和受伤儿童的艾德护理质量差异相关。研究设计：拟议的研究将是一项回顾性横断面研究，涉及600名儿童，他们在PECARN中接受12个选定的ED治疗。每份去识别病历将由从8名审查员中随机选择的4名医生专家审查员进行审查。为了验证该仪器，我们将比较我们的结果与客观措施，这些措施是根据循证指南和专家共识（Gausche-Hill仪器）为哮喘、热性惊厥、胃肠炎和头部创伤治疗的患者制定的。我们还将根据处置的适当性（使用Re-PEAT和PRISA II）比较各组，并与其他评审员进行交叉验证，从而验证该工具。然后，我们将研究几家医院，艾德，医生，病人和介绍因素与护理质量使用标准的多变量回归方法和多层次建模。结论：我们的研究结果和本研究中建立的隐性审查护理质量工具将帮助研究人员，提供者和医疗保健政策制定者确定最佳实践，并提出建议，标准和政策，旨在解决护理中的差异，以提高向全国急诊科儿童提供的护理质量。 公共卫生相关性：我们提出的研究将验证一个结构化的隐性质量工具，本研究的结果可供医疗保健学者、研究人员、提供者和政策制定者用于制定质量基准、标准和政策的建议，以提高向全国急诊科儿童提供的护理质量。

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