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

项目摘要 总结：本项目的总体目标是进一步验证护理质量工具 它可以用来衡量和改善在紧急情况下向儿童提供的护理质量 部门（艾德）。为了帮助实现这一目标，我们将与各国专家合作， 儿科艾德研究网络，儿科急诊应用研究网络（PECARN）。 基于专家医师审查的护理质量工具将应用于600例样本 在12家异质性PECARN医院急诊室接受治疗的儿童。有了这个工具，我们希望 确定不同环境（包括不同类型的ED）之间的护理质量差异， 接受过不同培训的医生和几个患者因素，包括性别、患者种族/民族，以及 付款人来源一旦确定了这些因素，就可以确定最佳做法， 为提高向各地区急诊科就诊的儿童提供的护理质量而提出的建议 全国 目的和目标：我们的长期目标是创造一个普遍的护理质量 该工具可用于提高在ED中为儿童提供的护理质量。 本学期的目的是重新评估结构化内隐量表的一致性、信度和结构效度 评估工具，用于衡量向ED儿童提供的护理质量，以及 确定与下列因素相关的可修改因素（医院、艾德、医生、患者和表现因素 全美急性病和受伤儿童的艾德护理质量差异 研究设计：本研究是一项回顾性横断面研究，纳入600名儿童 他们在PECARN的12个选定的ED中出现。每一份去身份化的病历都将被审查 由从8名评审员中随机选择的4名医生专家评审员进行。验证 工具，我们将比较我们的结果，以客观的措施，从证据为基础的 指南和专家共识（Gausche-Hill仪器），用于治疗哮喘、发热 癫痫肠胃炎和头部外伤我们还将通过比较组来验证仪器 基于处置的适当性（使用Re-PEAT和PRISA II），并与 其他评论家然后，我们将检查几家医院，艾德，医生，病人和介绍 使用标准的多变量回归方法和多水平的护理质量相关因素 建模 结论：我们的研究结果和内隐审查质量的护理文书建立在这一点上， 这项研究将帮助研究人员、医疗服务提供者和医疗保健政策制定者确定最佳做法， 旨在解决护理不平等问题以提高质量的建议、标准和政策 of care护理delivered交付to children儿童presenting介绍to ED ED ED在全国各地.

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.