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

项目摘要 摘要：该项目的总体目标是进一步验证护理质量工具 可以用来衡量和改善紧急情况下向儿童提供的护理质量 部门(ED)。为了帮助实现这一目标，我们将与各国专家进行广泛的合作 儿科急诊研究网络、儿科急救应用研究网络(PECARN)。 护理质量量表，基于专家医生的审查，将应用于600个样本 儿童在12个异质的PECARN医院急诊室接受治疗。有了这台仪器，我们希望 确定包括不同类型急救在内的不同环境中的护理质量差异， 受过不同培训的医生，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，就可以确定最佳实践并制定策略 为提高向急诊室提供的儿童的护理质量提出的建议 这个国家。 目标和目标：我们的长期目标是创造可推广的护理质量 可用于提高教育署儿童护理质量的工具。简而言之- 术语目标是重新评估结构化内隐问卷的一致性、信度和结构效度 审查文书，衡量向急诊室提供的儿童的护理质量，并 确定与以下各项相关的可修改因素(医院、急诊科、医生、患者和陈述因素) 美国各地急症和受伤儿童急诊护理质量的差异 研究设计：建议的研究将是一项对600名儿童进行的回顾性横断面研究。 他们在PECARN中向12名选定的急救人员发表演讲。将审查每一份未确认身份的病历 由从8名评审员中随机挑选的4名内科专家评审员撰写。要验证 我们将把我们的结果与基于证据的客观衡量标准进行比较。 治疗哮喘、发热患者的指南和专家共识(Gausche-Hill仪器) 癫痫、胃肠炎和头部创伤。我们还将通过比较小组来验证该工具 基于处置的适当性(使用REPEAT和PRISA II)，并与 其他评论者。然后我们将检查几家医院、急诊室、内科医生、患者和演示文稿 使用标准多变量回归方法和多水平的与护理质量相关的因素 模特儿。 结论：我们的研究结果和在本研究中建立的隐性护理质量评价工具 研究将帮助研究人员、提供商和医疗保健政策制定者确定最佳实践并制定 旨在解决护理差距以提高质量的建议、标准和政策 向全国各地的急诊室的儿童提供护理的情况。

Project Summary Summary: 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 hospital, 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.