Pediatric Respiratory Illness Inpatient Measurement System Study

项目总结/摘要 护理质量可以通过评估护理的结构、过程或结果来衡量。然而，在这方面， 护理过程的要素并不意味着质量，直到它们与理想结果的关系已经确定， 确立了习在儿科，很少有研究检查继发于小 具有任何特定病症的患者的样本量和易于测量的结果的罕见发生 (e.g.死亡）。因此，大多数儿科实践指南包括基于专家的建议， 一致意见，而不是科学证据，建立了建议的护理之间的联系 过程和结果。在许多情况下，我们假设提供符合这些指南的护理将 带来更好的结果。 在国家心肺血液研究所的资助下，我们开发了一种 严格设计的护理质量评估工具，儿科呼吸系统疾病住院患者测量 系统（PRIMES）。PRIMES是一种质量测量工具，其结构用于使用 五种呼吸系统疾病的病历数据：哮喘、细支气管炎、哮吼、社区获得性 肺炎和囊性纤维化肺恶化。该工具评估了在医疗机构中提供的护理过程， 儿科急诊科（艾德）和住院设置，其内容主要基于既定的 专家共识实践指南。 我们建议通过评估以下因素之间的关系来进行PRIMES的结果验证研究： 工具中包含的护理过程的遵守程度、改善的结果和护理成本。使用 PRIMES，我们将对一家医院收治的3,000名患者进行详细的医院管理评估 五家美国儿童医院属于住院儿科研究机构（PRIS） 网络我们将使用经验证的调查评估健康相关生活质量（HRQOL）的改善 在三个时间点测量：指数入院前一个月（基线），入院当天， 出院后几周。我们还将评估索引艾德访视和住院的护理费用 住院时间（LOS）、30天艾德回访和再入院。拟议的研究将大大增加 我们对坚持儿科护理推荐标准与 保健成果。如果发现可以预测重要的结果，PRIMES可以用于识别 呼吸道疾病护理，其中最需要质量改进工作，并提供有效的性能 比较全国照顾儿童的医院。

PROJECT SUMMARY/ABSTRACT Quality of care can be measured by assessing the structure, process, or outcomes of care. However, elements of care processes do not signify quality until their relationship to desirable outcomes has been established. In pediatrics, there are few studies examining the process-outcome link secondary to small sample sizes of patients with any particular condition and the rare occurrence of readily measured outcomes (e.g. death). As a result, most pediatric practice guidelines include recommendations based on expert consensus opinion rather than scientific evidence establishing a link between the recommended care processes and outcomes. In many cases, we assume that providing care consistent with these guidelines will result in better outcomes. Under funding from the National Heart Lung Blood Institute, we have developed and pilot tested a rigorously designed quality of care assessment tool, the Pediatric Respiratory Illness Inpatient Measurement System (PRIMES). PRIMES is a quality measurement tool that is structured to generate quality scores using medical records data for five respiratory conditions: asthma, bronchiolitis, croup, community acquired pneumonia, and cystic fibrosis pulmonary exacerbation. The tool assesses processes of care provided in the pediatric emergency department (ED) and inpatient settings and its content is largely based on established expert consensus practice guidelines. We propose to conduct an outcome validation study of PRIMES by assessing the relationship between level of adherence to the processes of care included in the tool, improved outcomes, and costs of care. Using PRIMES, we will conduct a detailed assessment of the hospital management of 3,000 patients admitted to one of five United States children's hospitals belonging to the Pediatric Research in Inpatient Settings (PRIS) Network. We will assess improvements in health related quality of life (HRQOL) using a validated survey measure at three time points: the month prior to the index admission (baseline), the day of admission, and two weeks after discharge. We will also assess costs of care for the index ED visit and hospital admission as well as length of stay (LOS), 30-day return ED visits, and readmissions. The proposed study will substantially add to our understanding of the relationship between adhering to recommended standards of care in pediatrics and health care outcomes. If found to predict important outcomes, PRIMES could be used to both identify areas of respiratory illness care where quality improvement efforts are most needed and provide valid performance comparisons across hospitals caring for children nationally.