REcovery after in hoSpital Cardiac arrest: late outcomes and Utilization_ResCU

住院心脏骤停后的康复：晚期结果和 Utilization_ResCU

• 批准号: 8676187
• 负责人: Theodore J Iwashyna
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8676187
• 关键词: Acute; Address; Admission activity; Area; Benchmarking; Cardiology; Caring; Clinical; Cohort Studies; Communication; Data; Data Sources; Discipline; Disease; Enrollment; Evaluation; Feedback; Future; Goals; Health Status; Heart Arrest; Heart failure; Heterogeneity; Hospitals; Independent Living; Individual; Informatics; Inpatients; Intensive Care Units; Knowledge; Leadership; Life; Link; Long-Term Care; Measures; Medical; Monitor; Morbidity - disease rate; Myocardial Ischemia; Nursing Homes; Organizational Culture; Outcome; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Pattern; Physicians; Provider; Quality of life; Recovery; Relative (related person); Reporting; Research; Resources; Risk; Risk Adjustment; Role; Sepsis; Services; Site; Source; Surveys; Survivors; System; Telephone; Time; United States; Variant; Veterans; adverse outcome; base; clinical decision-making; cohort; cost; experience; follow-up; health care service utilization; high risk; improved; insight; interest; medical specialties; mortality; multilevel analysis; programs; prospective; statistics; tool

RECOVERY AFTER IN-HOSPITAL CARDIAC ARREST: LATE OUTCOMES & UTILIZATION (RESCU) ABSTRACT In-hospital cardiac arrest (IHCA) is common, life-threatening, and hospitals allocate substantial resources to care for it. Inpatient survival after IHCA has improved nationally over the last decade, although similar statistics within the VHA are unavailable. More importantly, however, few contemporary data exist - either nationally or in the VHA - on the long-term survival, care requirements or health status of patients with IHCA. This is a critical "gap" in knowledge: information on late outcomes after IHCA is essential for clinical decision-making, especially as emerging data suggest survivors may do reasonable well after discharge. Although hospitals do much to care for patients with IHCA, little research to date has been done on understanding how these efforts may be associated with the end results of care. No empirical analyses have linked hospital micro-systems or organizational culture to the wide outcome variations noted after IHCA in the "real-world". Within the VHA, growing concerns about quality have led to an active VHA Directive 2008-063 that specifically calls for data on IHCA to be "aggregated, analyzed, compared internally over time and externally with other sources of information when available (benchmarking)" and "used to identify and implement desired changes" at both hospital and VISN-levels. In this context, IHCA also is now a high priority for the Ischemic Heart Disease (IHD) Quality Enhancement Research Initiative (QUERI) and VHA National Program Director for Cardiology. Yet while the VHA has demonstrated clear interest in this area and established world-class tools for measuring inpatient quality in other settings, no operational systems have been constructed to provide feedback on IHCA. Accordingly, the fundamental goal of the ResCU proposal is to understand patterns of long-term outcomes and healthcare utilization across hospitals after IHCA and then to use these insights to develop new strategies for quality improvement both within the VHA and elsewhere. Its 3 Aims will: (1) measure long-term outcomes (including health status) and healthcare utilization in patients after IHCA within the VHA and then determine key patient-level factors that are linked to adverse outcomes; (2) identify hospital-level factors that are associated with long-term outcomes and healthcare utilization; and (3) determine the extent of variation in long-term, risk-adjusted outcomes across hospitals and VISNs. This project will be performed largely as a retrospective cohort study using existing data on all hospitalized Veterans who suffered IHCA in the United States between 2005 and 2012. For these objectives, patient-level data on over 4,500 survivors of IHCA from the Inpatient Evaluation Center (IPEC) will be linked to the Medical SAS files and other administrative data sources-both inside VHA and non-VHA. For a subset of ~540 survivors enrolled in a prospective cohort, long-term outcomes will also include measures of self-reported health status over time, collected via a telephone-based survey. Multilevel modeling will be performed to determine heterogeneity in patients' long-term outcomes, and the extent to which such heterogeneity is attributable to the site they received care. In the future, this proposal's findings will directly enhance Veterans' care by: improving clinical decision-making (Aim 1); identifying hospital-level factors associated with improved outcomes (Aim 2); and making possible risk-adjusted measures that may be used for feedback and benchmarking to guide quality efforts (Aim 3).

住院心脏骤停后的恢复：晚期结局和利用（RESCU） 摘要 院内心脏骤停（IHCA）是常见的，危及生命，医院分配大量资源， 在过去的十年里，IHCA后的住院患者生存率在全国范围内有所改善，尽管类似的统计数据显示， 在VHA中，没有可用的。然而，更重要的是，几乎没有当代数据存在-无论是国家还是 在VHA中-关于IHCA患者的长期生存、护理需求或健康状况。这是一 知识的关键“差距”：关于IHCA后晚期结局的信息对于临床决策至关重要， 特别是新的数据显示，幸存者在出院后可能会做得很好。 虽然医院做了很多照顾IHCA患者，但迄今为止， 了解这些努力如何与护理的最终结果相关联。没有实证分析 将医院的微观系统或组织文化与IHCA后的广泛结果差异联系起来， “真实世界”在VHA内部，对质量的日益关注导致了VHA指令2008-063的生效 这特别要求对IHCA的数据进行“汇总、分析、内部比较， 外部与其他信息来源（如有）（基准）”和“用于识别和 在医院和VISN层面实施所需的变革。在这种情况下，国际人道主义援助也是一个高度优先事项 缺血性心脏病（IHD）质量增强研究倡议（QUERI）和VHA国家 心脏病学项目主任然而，尽管VHA对这一领域表现出了明显的兴趣， 建立了世界一流的工具来衡量住院病人的质量在其他设置，没有操作系统， 为IHCA提供反馈。 因此，ResCU提案的基本目标是了解长期结果的模式， IHCA后，各医院的医疗保健利用率，然后利用这些见解制定新的战略， 在VHA和其他地方的质量改进。它的三个目标是：（1）衡量长期结果 （包括健康状况）和VHA内IHCA后患者的医疗保健利用情况，然后确定 与不良结局相关的关键患者水平因素;（2）确定 与长期结果和医疗保健利用相关;（3）确定 长期的，风险调整的结果在医院和VISN。 本项目将主要作为一项回顾性队列研究，使用所有住院患者的现有数据。 2005年至2012年期间在美国遭受IHCA的退伍军人。为了实现这些目标， 来自住院患者评估中心（IPEC）的4,500多名IHCA幸存者的数据将与医疗信息系统相关联。 SAS文件和其他管理数据源-包括VHA内部和非VHA内部。对于~540的子集 对于入选前瞻性队列的幸存者，长期结局还将包括自我报告的 通过电话调查收集的一段时间内的健康状况。将进行多层次建模， 确定患者长期结局的异质性，以及这种异质性的程度 他们接受护理的地点。在未来，这项提案的调查结果将直接提高退伍军人的 护理：改善临床决策（目标1）;确定与改善相关的医院级因素 （目标2）;以及制定可能的风险调整措施， 制定基准以指导质量工作（目标3）。