Understanding Variation in Failure to Rescue in the Eldery

描述（由申请人提供）： 每年死于住院手术的 100,000 名美国人中，绝大多数是老年患者。各医院死亡率的巨大差异表明还有很大的改善空间。最近的研究表明，这种差异主要取决于医院在并发症发生后识别和处理并发症的成功程度。因此，最大限度地减少“抢救失败”（即重大并发症后的死亡）对于降低手术死亡率可能至关重要。不幸的是，之前的研究并未就医院如何在这方面进行改进提供可行的见解。更好地了解微系统层面的医院结构，包括与 ICU 人员配置、医生覆盖范围和快速反应团队相关的详细信息至关重要。其他组织属性——包括员工士气、团队合作、沟通和安全态度——对于最大限度地减少救援失败可能更为重要。为了探讨这些问题，我们提出了一项多中心研究，涉及 34 家参与密歇根手术质量协作组织 (MSQC) 的医院，这是美国最大的基于人群的协作质量改进计划。我们将首先评估是否存在与 FTR 潜在相关的微系统资源，包括人员配置和组织、快速响应团队的结构和功能以及培训和质量改进计划等方面。在我们的第二个具体目标中，我们将使用安全和团队氛围调查及其与医院特定 FTR 率的关联来评估安全态度和文化，针对参与术后患者护理的主要单位的临床领导者和护理人员。最后，我们将使用安全组织量表评估与安全相关的实践和行为。我们假设 FTR 率高的医院资源较少，在安全氛围、团队合作和沟通方面得分较差。该项目将产生直接的人口层面影响，因为我们的研究结果为旨在降低死亡率的干预措施提供了信息 密歇根州以及其他地方的外科手术患者。这项研究的结果还将为大型付款人（包括 CMS）和监管机构（特别是 JCAHO）提供信息，帮助他们制定提高美国住院手术安全性的激励措施和标准。

DESCRIPTION (provided by applicant): Elderly patients comprise a large majority of the 100,000 Americans who die every year undergoing inpatient surgery. Wide variation in mortality rates across hospitals suggests substantial opportunities for improvement. Recent research suggests that such variation is determined primarily by how successfully hospitals recognize and manage complications once they occur. Thus, minimizing "failure to rescue" (i.e., death following a major complication) may be essential in efforts to reduce surgical mortality. Unfortunately, previous research does not provide actionable insights into how hospitals can improve in this regard. A better understanding of hospital structure at the micro-system level, including details related to ICU staffing, physician coverage, and rapid response teams, is essential. Other organizational attributes-including staff morale, teamwork, communication, and attitudes toward safety-could be even more crucial in minimizing failure to rescue. To explore these issues, we propose a multi-center study involving 34 hospitals participating in the Michigan Surgical Quality Collaborative (MSQC), the largest population-based collaborative quality improvement program in the United States. We will first assess the presence of micro-system resources potentially related to FTR, including aspects of staffing and organization, the structure and function of rapid response teams, and training and quality improvement programs. In our second specific aim, we will evaluate safety attitudes and culture using the Safety and Teamwork Climate Survey and their associations with hospital-specific FTR rates, targeting clinical leaders and caregivers of the major units involved in the care of postoperative patients. Finally, we will assess safety-related practices and behaviors, using the Safety Organizing Scale. We hypothesize that hospitals with high FTR rates will have fewer resources and score worse with regards to safety climate, teamwork and communication. This project will have direct, population-level impact as our findings inform interventions aimed at reducing mortality in surgical patients in Michigan, and ultimately elsewhere. Results from this study will also inform large payers (including CMS) and regulators (particularly JCAHO) as they set incentives and standards for enhancing the safety of inpatient surgery in the United States.