The Quality of Emergency Care and and Relationship to Patient-Reported Outcomes

描述（由申请人提供）：医学研究所（IOM）急诊护理未来委员会最近的一份报告将美国医院急诊护理描述为“处于临界点”。“由于对急诊科（艾德）服务的需求与提供这些服务所需的资源之间的不匹配，美国的许多急诊科正在努力为向他们提供优质急诊护理的病人提供服务。该应用程序的短期和长期目标是通过识别影响患者安全性、及时性、有效性和ED护理效率的因素，实施和评估有希望的干预措施以提高艾德护理质量，并成为独立的研究者，从而促进对艾德护理质量的研究。为了实现这些目标，我的职业发展计划包括以下组成部分：（1）确定高级导师和合作者谁将建议我;（2）通过正式课程学习新技能的收购;（3）在机构内的护理质量会议以及国家会议出席;和（4）研究项目，这将提高我在这一领域的专业知识进行。提出了2个研究项目。第一个有两个阶段。第1阶段将使用回顾性队列设计检查患者、提供者和系统因素之间的关系以及艾德护理的质量，该设计涉及审查约2，500名患者的电子病历数据，这些患者在15个月期间因胸部或腹部疼痛到艾德就诊。在第2阶段，我们将采用前瞻性队列设计，检查1，260例艾德胸痛或腹痛患者接受的护理质量与患者报告的结局之间的关系，特别是自我报告的健康状况、患者对艾德访视的满意度和对艾德出院指导的依从性。2期受试者将在首次艾德访视期间和一周后接受访谈。最后的项目将试点干预，旨在提高艾德护理质量。研究环境高度支持本申请的目标。我将与机构内的几个质量和安全研究小组合作。我还将与我的部门成员密切合作，为我们的卫生系统制定一个积极主动的护理质量监测计划。

DESCRIPTION (provided by applicant): A recent report by the Institute of Medicine's (IOM) Committee on the Future of Emergency Care characterized hospital-based emergency care in the US as "at the breaking point." As a result of the mismatch between demand for emergency department (ED) services and the resources needed to provide them, many EDs in the US are struggling to provide quality emergency care to the patients who present to them. The short and long-term goals of this application are to contribute to research on the quality of ED care by identifying factors that influence patient safety, timeliness, effectiveness and efficiency of EDcare, implementing and evaluating promising interventions to improve the quality of ED care and becoming an independent investigator. To achieve these goals, my career development plan includes the following components: (1) identification of senior mentors and collaborators who will advise me; (2) acquisition of new skills through formal coursework; (3) attendance at quality of care meetings within the institution as well as national conferences; and (4) conduct of research projects that will advance my expertise in this area. There are 2 research projects proposed. The first one has two phases. Phase 1 will examine relationship among patient, provider and system factors that and the quality of ED care using a retrospective cohort design that involves review of electronic medical record data for approximately 2,500 patients who present to the ED with chest or abdominal pain during a 15 month period. In phase 2, we will use a prospective cohort design to examine the relationship between the quality of care received for 1,260 ED patients with chest or abdominal pain and patient-reported outcomes, specifically self-reported health, patient satisfaction with the ED visit and compliance with ED discharge instructions. Subjects in phase 2 will be interviewed during their index ED visit and one week later. The final project will pilot an intervention designed to improve the quality of ED care. The research environment is highly supportive of the goals of this application. I will collaborate with several quality and safety research groups within the institution. I will also work closely with members of my department to develop a proactive, quality of care surveillance program for our health system.