Understanding Variation in Failure to Rescue in the Eldery

描述（由申请人提供）：老年患者占每年因住院手术死亡的10万美国人的绝大多数。各医院的死亡率差异很大，这表明有很大的改善机会。最近的研究表明，这种变化主要取决于医院在并发症发生后如何成功地识别和管理并发症。因此，最小化“救援失败”（即，主要并发症后死亡）可能是降低手术死亡率的关键。不幸的是，以前的研究并没有提供关于医院如何在这方面改进的可操作的见解。在微观系统层面上更好地了解医院结构，包括与ICU人员配置，医生覆盖范围和快速反应团队相关的细节，是至关重要的。其他组织属性包括员工士气、团队合作、沟通和对安全的态度在最大限度地减少救援失败方面可能更为关键。为了探讨这些问题，我们提出了一项多中心研究，涉及34家参与密歇根州外科质量合作（MSQC），在美国最大的基于人口的协作质量改进计划的医院。我们将首先评估可能与FTR相关的微系统资源的存在，包括人员配备和组织方面，快速反应团队的结构和功能，以及培训和质量改进计划。在我们的第二个具体目标中，我们将使用安全和团队合作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，目标是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率高的医院将拥有更少的资源，在安全环境、团队合作和沟通方面得分更低。该项目将产生直接的人口影响，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。 密歇根州的外科病人，最终在其他地方。这项研究的结果还将告知大型支付者（包括CMS）和监管机构（特别是JCAHO），因为他们为提高美国住院手术的安全性制定了激励措施和标准。

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.