Understanding and Preventing Pediatric Asthma Readmissions

描述（由申请人提供）：儿童哮喘再入院率为每年30%或更高，其中许多是可以预防的。影响成人和儿童再入院的因素包括患者特征、住院和门诊管理，以及围绕护理转变的住院结构和过程因素。然而，文献中很少有干预措施被评估，以解决儿童哮喘或任何其他儿科疾病的这些因素。该职业发展奖项旨在通过以下具体目标解决文献中的这些空白：目标1：开发和验证儿童哮喘再入院的30天风险调整模型。这包括使用大型全州管理数据库开发风险调整模型，这将提供一个新的贡献，因为它将确定所有医院（三级保健和社区，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，作为我们下一个目标的重点。目的2：使用定性方法确定可能与较低（或较高）儿科哮喘再入院率相关的医院级干预措施。定性方法将使我们能够找出文献中尚未描述的导致再入院的干预措施类型和因素。目的3：确定医院层面预防哮喘再入院的干预措施与哮喘再入院风险调整率之间的关系。为此，我们将根据先前对儿童和成人再入院文献的回顾以及定性访谈的结果，制定并实施一项定量调查，以评估预防或减少儿童哮喘再入院的干预措施的存在。我们将使用结果并评估干预的存在与Aim 1的风险调整再入院率之间是否存在关联。这三个目标将为儿科哮喘再入院率的医院差异以及可能的干预措施提供重要的见解，以帮助预防它们。一个多学科的指导委员会，其专业知识涵盖质量评估和改进的相关学科(博士。杜德利和奥尔巴赫)，哮喘和健康服务研究（卡巴纳博士），定性和定量研究（卡巴纳博士）。Halpern-Felsher和Dudley)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质量研究方面的专业知识，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，即制定一项受到全国尊重的研究计划，以提高儿科住院治疗的质量，同时进一步推进NICHD的使命，即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。

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.