Improving the Quality of Pediatric Emergency Care Using an Electronic Medical Rec

使用电子医疗记录提高儿科急诊护理的质量

• 批准号: 8932006
• 负责人: Elizabeth Rachel Alpern
• 金额: $ 42.53万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2017-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8932006
• 关键词: Improving; Quality; Pediatric; Emergency; Care

Project Summary/Abstract Approximately 20% of all children in the US will have at least one Emergency Department (ED) visit each year. Patients and caregivers expect clinicians to deliver high quality emergency care, yet many children do not receive appropriate care under the current system. The Institute of Medicine report, "Emergency Care for Children: Growing Pains," notes that the delivery of care should be built on a strong foundation in which emergency care is based on scientific evidence, data are collected so clinicians can learn from past experience, and system performance is monitored to ensure quality.While EDs routinely collect substantial patient data with the potential to provide information on the quality of care provided, the capacity to capture, analyze and report these data back to front-line clinicians capable of acting to improve health care delivery has been limited.Leveraging advances in health information technology to access patient-centric clinical data, researchers can measure and identify variation in performance and outcomes, enhancing the ability to design and implement interventions to improve outcomes and quality of care across multiple settings. The increasing use of the electronic health record (EHR) in EDs provides a unique opportunity. Utilizing the infrastructure of the Pediatric Emergency Care Applied Research Network (PECARN), this proposal will innovatively capture EHR data to implement and report performance measures with the ultimate goal of improving the quality of emergency care for children. This proposal will develop an emergency care visit registry for pediatric patients from EHR clinical data which will serve as the foundation for the current and future studies, precluding the need for resource-intensive chart review. Emergency care performance measures will be derived from registry data and we will measure variability among sites and individual clinicians. Data from the registry and qualitative methods will be used to set benchmarks of care. We will design site- and clinician-level Quality Performance Measure Report Cards that will be generated from the registry and distributed monthly. The registry will be utilized to evaluate the performance measures in a prospective manner for improvement in the measures themselves as well as decreased variation in performance across practitioners. Significant improvements by individual practitioners should also manifest as improvement at the site level. We will test the hypothesis that providing regular performance measure feedback will improve performance and decrease variation among ED clinicians using a staggered time-series study. The proposed project, thus, has enormous potential to improve our ability to evaluate systems of health care delivery, as well as to lead to improvements in the quality of care provided to acutely ill or injured children. Although this proposal centers on health care delivered to children in EDs, the principles delineated apply to all components of the healthcare system that collect electronic patient data. Accordingly, this proposal should be viewed as having wide applicability for comparative effectiveness research and quality improvement across all healthcare domains.

项目总结/摘要 美国大约20%的儿童每年至少有一次急诊（艾德）就诊。 患者和护理人员希望临床医生提供高质量的急诊护理，但许多儿童并不这样做。 在现行制度下得到适当照顾。医学研究所报告，“紧急护理， 儿童：成长的烦恼》指出，提供护理应建立在一个坚实的基础上， 急救护理是基于科学证据，收集数据，使临床医生可以从过去的经验中学习 经验和系统性能进行监测，以确保质量。虽然ED例行收集大量 患者数据有可能提供有关所提供护理质量的信息，捕获能力， 分析这些数据并将其报告给能够采取行动改善医疗保健服务的一线临床医生， 利用卫生信息技术的进步来获取以患者为中心的临床数据， 研究人员可以测量和识别性能和结果的变化，提高设计能力， 并实施干预措施，以改善多种环境下的护理结果和质量。日益 在急诊室使用电子健康记录（EHR）提供了一个独特的机会。利用基础设施， 儿科急诊护理应用研究网络（PECARN），这项建议将创新地捕捉 EHR数据用于实施和报告绩效指标，最终目标是提高 儿童紧急护理。该提案将为儿科患者开发一个紧急护理访视登记处 EHR临床数据将作为当前和未来研究的基础， 需要进行资源密集型图表审查。急诊护理绩效指标将来自登记研究 数据，我们将测量研究中心和个体临床医生之间的差异。来自登记处的数据和定性数据 将使用各种方法来设定护理基准。我们将设计研究中心和临床医生级别的质量绩效 将从登记处生成并每月分发的测量报告卡。书记官处将 用于以前瞻性方式评价绩效指标，以改进指标 他们自己，以及减少在实践者的表现变化。显著改善， 个别从业人员也应表现为现场一级的改进。我们将检验这个假设， 提供定期的绩效评估反馈将提高绩效并减少艾德之间的差异 临床医生使用交错时间序列研究。因此，拟议的项目具有巨大的改进潜力。 我们评估医疗保健提供系统的能力，以及提高医疗质量的能力 提供给严重生病或受伤的儿童。虽然这项提案的中心是在1999年向儿童提供的医疗保健， ED，所描述的原则适用于收集电子患者的医疗保健系统的所有组件 数据因此，这项建议应被视为具有广泛的适用性，以取得比较效果 在所有医疗保健领域进行研究和质量改进。

项目成果

Racial/Ethnic Differences in ED Opioid Prescriptions for Long Bone Fractures: Trends Over Time.

长骨骨折 ED 阿片类药物处方的种族/民族差异：随时间的趋势。

• DOI: 10.1542/peds.2021-052481
• 发表时间: 2021
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Goyal,MonikaK;Drendel,AmyL;Chamberlain,JamesM;Wheeler,Justin;Olsen,Cody;Grundmeier,RobertW;Cook,Larry;Bajaj,Lalit;Babcock,Lynn;Zorc,JoesephJ;Johnson,Tiffani;Alpern,ElizabethR;PediatricEmergencyCareAppliedResearchNetwork
• 通讯作者: PediatricEmergencyCareAppliedResearchNetwork

Racial/Ethnic Differences in Pediatric Emergency Department Wait Times.

• DOI: 10.1097/pec.0000000000002483
• 发表时间: 2022-02-01
• 期刊: Pediatric emergency care
• 影响因子: 1.4
• 作者: Johnson TJ;Goyal MK;Lorch SA;Chamberlain JM;Bajaj L;Alessandrini EA;Simmons T;Casper TC;Olsen CS;Grundmeier RW;Alpern ER;Pediatric Emergency Care Applied Research Network (PECARN)
• 通讯作者: Pediatric Emergency Care Applied Research Network (PECARN)

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• DOI: 10.1002/art.40923
• 发表时间: 2019
• 期刊: Arthritis & rheumatology (Hoboken, N.J.)
• 作者: Kim,AlfredHJ;Strand,Vibeke;Atkinson,JohnP
• 通讯作者: Atkinson,JohnP