Understanding and Preventing Pediatric Asthma Readmissions

了解和预防小儿哮喘再入院

• 批准号: 8293031
• 负责人: Naomi Shula Bardach
• 金额: $ 13.96万
• 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/8293031
• 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.

描述（由申请人提供）：小儿哮喘再入院率每年为30%或更高，其中许多是可以预防的。成人和儿科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结构和过程因素。然而，很少有干预措施已在文献中评估，解决这些因素在儿科哮喘或任何其他儿科疾病。该职业发展奖旨在通过以下具体目标来解决文献中的这些差距：目标1：开发和验证小儿哮喘再入院的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，提供新的贡献，因为它将确定所有医院（三级护理和社区，高容量和低容量）的再入院情况。它还使我们能够确定高绩效和低绩效的医院，以便在我们的下一个目标中重点关注。目标二：使用定性方法确定可能与较低（或较高）儿童哮喘再入院率相关的医院级干预措施。定性的方法将使我们能够得出的干预措施和因素，有助于再入院尚未在文献中描述。目标三：确定预防哮喘再入院的医院级干预措施与哮喘再入院风险调整率之间的关系。在这个目标中，我们将开发和管理一个定量调查，以评估存在的干预措施，以防止或减少儿童哮喘再入院，根据以前的审查文献的儿科和成人再入院，以及从定性访谈的结果。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。这三个目标将提供重要的见解，医院的变化，儿童哮喘再入院率，以及可能的干预措施，以帮助防止他们。一个多学科指导委员会，其专业知识涵盖质量评估和改进（达德利和奥尔巴赫博士）、哮喘和卫生服务研究（卡巴纳博士）以及定性和定量研究（哈尔彭-费尔舍博士和达德利博士）的相关学科，将指导研究议程的进展。他们的指导，以及由K23奖促进的重点培训和研究计划，将发展我在儿科护理研究质量方面的专业知识，重点是儿科再入院。这一教育和研究议程将使我能够实现我的目标，即制定一个全国受人尊敬的研究计划，以提高儿科住院护理的质量，同时促进NICHD的使命，确保所有儿童都有机会充分发挥其潜力，过上健康和富有成效的生活。