Unexpected death after medical encounters: Measurement, reporting, and analysis

描述（由申请人提供）：每年在美国急诊科就诊的1.2亿患者中，85%出院回家，在门诊诊所就诊的10亿患者中，绝大多数出院回家。虽然定期测量和报告医院内死亡率，但由于卫生保健组织内部和组织之间的卫生信息系统支离破碎，要捕获卫生设施外的死亡人数要困难得多。因此，医疗服务提供者没有系统的方法来了解病人何时在被送回家后意外死亡，政策制定者也无法轻易衡量这些灾难性事件发生的频率。我提出了一系列相关的研究项目来追踪和分析医疗事故后的意外死亡，使用来自大型学术医院系统以及医疗保险索赔的数据，以确定与个体患者，提供者和系统相关的因素，增加此类事件的可能性。随后，我将使这些方法适应国际环境，因为那里的临床和管理数据不如美国完整。这项工作将对改善临床护理和卫生服务设计具有重要意义。此外，跟踪和报告意外过早死亡率的系统方法将是衡量卫生服务绩效和评估质量与成本之间权衡的有用方法。

DESCRIPTION (provided by applicant): Of the 120 million patients seen annually in US Emergency Departments, 85% are discharged home, as are the vast majority of the one billion patients seen in ambulatory clinics. While rates of in-hospital deaths are routinely measured and reported, deaths outside of health facilities are far more challenging to capture because of fragmented health information systems both within and among health care organizations. As a result, providers have no systematic way of knowing when a patient dies unexpectedly after being sent home, and policy makers cannot readily measure how frequently these catastrophic events occur. I propose a series of linked research projects to track and analyze unexpected deaths after medical encounters, using data from a large academic hospital system as well as Medicare claims, in order to identify factors related to individual patients, providers, and system that increase the likelihood of such events. I will subsequently adapt the methods to an international setting, where clinical and administrative data are less complete than in the US. This work would have important implications for improving both clinical care and health services design. In addition, a systematic method for tracking and reporting rates of unexpected early deaths would be a useful way to measure health services performance, and assess trade-offs between quality and cost. PUBLIC HEALTH RELEVANCE: Most of the 1.1 billion patients seen annually in emergency facilities or clinics return home after their visit, but neither doctors nor policy makers have any systematic way of identifying patients who die unexpectedly after being sent home. My project aims to track and analyze these events, with the goals of helping providers identify high-risk patients; understanding the health system factors that make errors of risk assessment more likely; and exploring whether rates of unexpected death after discharge can be used to measure and publicly report on the quality of care delivered by health services.