Understanding and Preventing Pediatric Asthma Readmissions

了解和预防小儿哮喘再入院

• 批准号: 8189587
• 负责人: Naomi Shula Bardach
• 金额: $ 13.89万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189587
• 关键词: Address; Admission activity; Adult; Affect; Ambulatory Care; Area; Asthma; Calibration; California; Caring; Characteristics; Child; Childhood; Childhood Asthma; Clinical; Communication; Communities; Complex; Data; Data Analyses; Data Collection; Development; Discipline; Disease; Ensure; Failure; Family; Goals; Health Services Research; High Prevalence; Hospitalized Child; Hospitals; Inpatients; Institution; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Literature; Measures; Medication Management; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minority; Mission; Modeling; Outcome; Outpatients; Patients; Pediatric Hospitals; Performance; Pharmaceutical Preparations; Physicians; Policies; Population; Populations at Risk; Prevalence; Process; Proxy; Publishing; Qualitative Methods; Quality of Care; Quality of life; Randomized Controlled Trials; Reporting; Research; Research Personnel; Research Training; Review Literature; Risk; Risk Adjustment; Rural; Sampling; Schools; Severity of illness; Structure; Survey Methodology; Surveys; Teaching Method; Testing; Training; Variant; Work; administrative database; base; data modeling; improved; insight; member; novel; patient population; peer; prevent; programs; safety net; statistics; tertiary care

DESCRIPTION (provided by applicant): Pediatric asthma readmissions occur at rates of 30% or higher annually and many of these are potentially preventable. Contributing factors to adult and pediatric readmissions include patient characteristics, inpatient and outpatient management, and inpatient structural and process factors around transitions of care. However, very few interventions have been evaluated in the literature addressing these factors in pediatric asthma or in any other pediatric disease. This career development award seeks to address these gaps in the literature through the following specific aims: Aim 1: To develop and validate a 30 day risk adjustment model for pediatric asthma readmissions. This includes the development of a risk adjustment model using a large statewide administrative database, providing a novel contribution as it will identify readmissions to all hospitals (tertiary care and community, high volume and low volume). It also allows us to identify high and low performing hospitals for focus in our next aim. Aim 2: To use qualitative methods to identify hospital-level interventions that may be associated with lower (or higher) pediatric asthma readmissions rates. Qualitative methods will enable us to draw out types of interventions and factors contributing to readmissions not yet described in the literature. Aim 3: To determine the association between the presence of hospital-level interventions to prevent asthma readmissions and the risk adjusted rate of asthma readmissions. In this aim, we will develop and administer a quantitative survey to assess for the presence of interventions to prevent or decrease pediatric asthma readmissions, based on a previous review of the literature on pediatric and adult readmissions, as well as from the results of the qualitative interviews. We will use the results and assess whether there is an association between the presence of an intervention and risk adjusted readmission rates from Aim 1. These three aims will provide important insights into hospital variations in pediatric asthma readmission rates as well as possible interventions to help prevent them. A multi-disciplinary mentoring committee whose expertise spans the relevant disciplines of quality assessment and improvement (Drs. Dudley and Auerbach), asthma and health services research (Dr. Cabana), and qualitative and quantitative research (Drs. Halpern-Felsher and Dudley) will guide the progress of the research agenda. Their mentorship, as well as a focused training and research plan facilitated by a K23 award, will develop my expertise in pediatric quality of care research with a focus on pediatric readmissions. This educational and research agenda will enable me to achieve my goal of developing a nationally-respected research program to improve the quality of pediatric inpatient care, while furthering the NICHD's mission of ensuring that all children have the chance to achieve their full potential to lead healthy and productive lives. PUBLIC HEALTH RELEVANCE: Findings from the proposed plan will be relevant to the academic and policy arenas and ultimately further the field of pediatric quality to improve patient outcomes. Pediatric readmissions are an undesirable outcome in and of themselves, and may be a useful indicator of modifiable processes or structural factors to improve quality of care. In addition, asthma has a greater prevalence in minority populations, who often have poorer outcomes compared to non-minority peers, and the focus on asthma in the proposed plan will increase our likelihood of improving outcomes for these more vulnerable and at-risk populations. Many questions remain regarding what leads to pediatric asthma readmissions and therefore how to intervene to prevent them. The proposed plan will help answer some of these questions.

描述（由申请人提供）：每年小儿哮喘再入院率达到 30% 或更高，其中许多是可以预防的。成人和儿童再入院的影响因素包括患者特征、住院和门诊管理以及围绕护理过渡的住院患者结构和流程因素。然而，文献中很少评估针对小儿哮喘或任何其他儿科疾病的这些因素的干预措施。该职业发展奖旨在通过以下具体目标来弥补文献中的这些空白： 目标 1：开发并验证儿童哮喘再入院的 30 天风险调整模型。这包括使用大型全州行政数据库开发风险调整模型，提供新颖的贡献，因为它将确定所有医院的再入院情况（三级护理和社区、高容量和低容量）。它还使我们能够识别绩效较高和绩效较差的医院，以重点关注我们的下一个目标。目标 2：使用定性方法来确定可能与较低（或较高）儿科哮喘再入院率相关的医院级别干预措施。定性方法将使我们能够找出文献中尚未描述的干预措施类型和导致再入院的因素。目标 3：确定预防哮喘再入院的医院级别干预措施与哮喘再入院风险调整率之间的关联。为此，我们将根据之前对儿科和成人再入院文献的回顾以及定性访谈的结果，制定和实施一项定量调查，以评估是否存在预防或减少儿科哮喘再入院的干预措施。我们将使用这些结果并评估干预措施的存在与目标 1 的风险调整再入院率之间是否存在关联。这三个目标将为了解儿科哮喘再入院率的医院差异以及帮助预防这些情况的可能干预措施提供重要见解。一个多学科指导委员会的专业知识涵盖质量评估和改进（Dudley 和 Auerbach 博士）、哮喘和健康服务研究（Cabana 博士）以及定性和定量研究（Halpern-Felsher 和 Dudley 博士）等相关学科，将指导研究议程的进展。他们的指导，以及由 K23 奖项推动的重点培训和研究计划，将发展我在儿科护理质量研究方面的专业知识，重点是儿科再入院。这项教育和研究议程将使我能够实现制定一项全国性的研究计划的目标，以提高儿科住院护理的质量，同时进一步推进 NICHD 的使命，即确保所有儿童都有机会充分发挥潜力，过上健康和富有成效的生活。 公共卫生相关性：拟议计划的研究结果将与学术和政策领域相关，并最终进一步推动儿科质量领域，以改善患者的治疗结果。儿科再入院本身就是一种不良结果，但可能是可修改流程或结构因素以提高护理质量的有用指标。此外，哮喘在少数族裔中的患病率较高，与非少数族裔相比，他们的预后往往较差，拟议计划中对哮喘的关注将增加我们改善这些更脆弱和高危人群的预后的可能性。关于导致儿童哮喘再入院的原因以及如何干预预防这些问题，仍然存在许多问题。拟议的计划将有助于回答其中一些问题。