Evaluating the safety and effectiveness of pediatric direct admissions to hospital

评估儿科直接入院的安全性和有效性

• 批准号: 8949006
• 负责人: JoAnna Leyenaar
• 金额: $ 15.14万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-06 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8949006
• 关键词: Evaluating; safety; effectiveness; pediatric; direct

 DESCRIPTION (provided by applicant): Dr. Leyenaar is a pediatric hospitalist and Assistant Professor of Pediatrics at Tufts University School of Medicine. Her goal is to become an independent clinician-investigator and a national leader in the care of hospitalized children, focused on improving health care efficiency while providing patient-centered care. Dr. Leyenaar's proposed career development plan incorporates mentored research and training in advanced statistics, qualitative methods, stakeholder engagement and implementation research as part of a PhD in Clinical and Translational Science. Dr. Leyenaar's mentorship team brings expertise in patient-centered outcomes research in a comparative effectiveness framework, guiding her career development. Dr. Lindenauer, primary mentor, is an accomplished investigator with an established record of mentoring investigators toward independent research careers. Dr. Leyenaar works in an environment extremely supportive of her success, with access to all of the resources required to achieve her long-term goals. In 2012, 1.8 million children were hospitalized in the United States, generating aggregate costs of 20.6 billion dollars. The majority of these children were admitted to hospitals through emergency departments (ED). For children who are medically stable, direct admission is an alternative approach involving referral to hospital without receiving care in the hospital's ED. Among children with timely access to outpatient healthcare providers, direct admission may offer benefits including improved coordination between health care providers, reduced ED volumes, and reduced healthcare costs. However, potential risks of direct admissions include delays in initial evaluation and management that might adversely impact patient safety. The goal of Dr. Leyenaar's research is to identify the pediatric populations, healthcare settings, and procedures that facilitate safe and effective direct admissions. She will accomplish this goal by: (1) comparing the outcomes of direct and ED admissions for common clinical conditions; (2a) characterizing the perspectives of stakeholders in the direct admission process; (2b) developing a consensus-driven guideline and identifying safety and quality indicators for direct admissions; and (3) pilot test the feasibility and acceptability of implementing this direct admission guidelin. Aim 1 will be accomplished using a large administrative database to conduct a retrospective cohort study of children hospitalized at structurally diverse hospitals in the United States, developing advanced statistical models to compare outcomes among children admitted directly to those admitted via EDs. Aim 2 will be accomplished by engaging parents, healthcare providers, payers and policymakers in deliberative discussions about their admission experiences and perspectives, followed by a Delphi process to develop a direct admission guideline and prioritize quality indicators. Aim 3 will involve implementation of this guideline at one hospital for six months, generating data vital to subsequent studies and Dr. Leyenaar's emergence as an independent investigator.

 描述（由申请人提供）：Leyenaar 博士是塔夫茨大学医学院的儿科住院医师和儿科助理教授。她的目标是成为一名独立的临床研究者和住院儿童护理领域的全国领导者，专注于提高医疗保健效率，同时提供以患者为中心的护理。 Leyenaar 博士提出的职业发展计划包括高级统计、定性方法、利益相关者参与和实施研究方面的指导研究和培训，作为临床和转化科学博士学位的一部分。 Leyenaar 博士的导师团队在比较有效性框架中提供以患者为中心的结果研究方面的专业知识，指导她的职业发展。主要导师 Lindenauer 博士是一位颇有成就的研究者，在指导研究者走向独立研究生涯方面有着良好的记录。 Leyenaar 博士的工作环境非常有利于她的成功，她可以获得实现长期目标所需的所有资源。 2012年，美国有180万儿童住院，总费用达206亿美元。这些儿童中的大多数是通过急诊室 (ED) 入院的。对于病情稳定的儿童，直接入院是另一种方法，涉及转诊到医院而不在医院急诊室接受护理。对于能够及时获得门诊医疗服务的儿童来说，直接入院可能会带来好处，包括改善医疗服务提供者之间的协调、减少急诊人数和降低医疗费用。然而，直接入院的潜在风险包括初步评估和管理的延迟，这可能会对患者安全产生不利影响。 Leyenaar 博士的研究目标是确定儿科人群、医疗保健环境和有助于安全有效直接入院的程序。她将通过以下方式实现这一目标：(1) 比较常见临床状况的直接入院和急诊入院的结果； (2a) 描述直接接纳过程中利益相关者的观点； (2b) 制定共识驱动的指南并确定直接入院的安全和质量指标； （三）试点测试实施本直录取指引的可行性和可接受性。目标 1 将使用大型管理数据库对美国不同结构的医院住院的儿童进行回顾性队列研究来实现，开发先进的统计模型来比较直接入院儿童与通过急诊室入院的儿童的结果。目标 2 将通过让家长、医疗保健提供者、付款人和政策制定者就他们的入学经验和观点进行深思熟虑的讨论来实现，然后通过德尔菲流程制定直接入学指南并优先考虑质量指标。目标 3 将涉及在 在一家医院进行了六个月的研究，产生了对后续研究以及 Leyenaar 博士成为一名独立研究者至关重要的数据。