Understanding and Preventing Pediatric Asthma Readmissions

了解和预防小儿哮喘再入院

• 批准号: 8843494
• 负责人: Naomi Shula Bardach
• 金额: $ 13.96万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8843494
• 关键词: Address; Admission activity; Adult; Affect; Ambulatory Care; Area; Asthma; Calibration; California; Caring; Characteristics; Child; Childhood; Childhood Asthma; Clinical; Communication; Communities; Complex; Data; Data Analyses; Data Collection; Development; Discipline; Disease; Ensure; Failure; Family; Goals; Health Services Research; High Prevalence; Hospitalized Child; Hospitals; Inpatients; Institution; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Literature; Measures; Medication Management; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Minority; Mission; Modeling; Outcome; Outpatients; Patients; Pediatric Hospitals; Performance; Pharmaceutical Preparations; Physicians; Policies; Population; Populations at Risk; Prevalence; Process; Proxy; Publishing; Qualitative Methods; Quality of Care; Quality of life; Randomized Controlled Trials; Reporting; Research; Research Personnel; Research Training; Review Literature; Risk; Risk Adjustment; Rural; Sampling; Schools; Severity of illness; Structure; Survey Methodology; Surveys; Teaching Method; Testing; Training; Variant; Work; administrative database; base; data modeling; improved; insight; member; novel; patient population; peer; prevent; programs; safety net; statistics; tertiary care

DESCRIPTION (provided by applicant): Pediatric asthma readmissions occur at rates of 30% or higher annually and many of these are potentially preventable. Contributing factors to adult and pediatric readmissions include patient characteristics, inpatient and outpatient management, and inpatient structural and process factors around transitions of care. However, very few interventions have been evaluated in the literature addressing these factors in pediatric asthma or in any other pediatric disease. This career development award seeks to address these gaps in the literature through the following specific aims: Aim 1: To develop and validate a 30 day risk adjustment model for pediatric asthma readmissions. This includes the development of a risk adjustment model using a large statewide administrative database, providing a novel contribution as it will identify readmissions to all hospitals (tertiary care and community, high volume and low volume). It also allows us to identify high and low performing hospitals for focus in our next aim. Aim 2: To use qualitative methods to identify hospital-level interventions that may be associated with lower (or higher) pediatric asthma readmissions rates. Qualitative methods will enable us to draw out types of interventions and factors contributing to readmissions not yet described in the literature. Aim 3: To determine the association between the presence of hospital-level interventions to prevent asthma readmissions and the risk adjusted rate of asthma readmissions. In this aim, we will develop and administer a quantitative survey to assess for the presence of interventions to prevent or decrease pediatric asthma readmissions, based on a previous review of the literature on pediatric and adult readmissions, as well as from the results of the qualitative interviews. We will use the results and assess whether there is an association between the presence of an intervention and risk adjusted readmission rates from Aim 1. These three aims will provide important insights into hospital variations in pediatric asthma readmission rates as well as possible interventions to help prevent them. A multi-disciplinary mentoring committee whose expertise spans the relevant disciplines of quality assessment and improvement (Drs. Dudley and Auerbach), asthma and health services research (Dr. Cabana), and qualitative and quantitative research (Drs. Halpern-Felsher and Dudley) will guide the progress of the research agenda. Their mentorship, as well as a focused training and research plan facilitated by a K23 award, will develop my expertise in pediatric quality of care research with a focus on pediatric readmissions. This educational and research agenda will enable me to achieve my goal of developing a nationally-respected research program to improve the quality of pediatric inpatient care, while furthering the NICHD's mission of ensuring that all children have the chance to achieve their full potential to lead healthy and productive lives.

描述(由申请人提供)：儿童哮喘再住院率每年达到30%或更高，其中许多是潜在的可预防的。成人和儿科再次住院的因素包括患者特征、住院和门诊管理，以及围绕护理过渡的住院结构和流程因素。然而，文献中很少对儿童哮喘或任何其他儿科疾病中的这些因素进行干预评估。这一职业发展奖旨在通过以下具体目标解决文献中的这些空白：目标1：开发和验证儿童哮喘再入院30天风险调整模型。这包括使用全州范围的大型行政数据库开发风险调整模型，提供新的贡献，因为它将确定所有医院的再入院情况(三级护理和社区，高容量和低容量)。它还使我们能够识别表现良好和表现不佳的医院，作为我们下一个目标的重点。目的2：使用定性方法来确定可能与较低(或较高)的儿童哮喘再住院率相关的医院水平的干预措施。定性方法将使我们能够得出文献中尚未描述的导致重新入院的干预措施和因素的类型。目的3：确定预防哮喘再入院的医院水平干预措施的存在与哮喘再入院率之间的关联。为此，我们将开发和管理一项量化调查，以评估是否存在预防或减少儿童哮喘再入院的干预措施，基于先前对儿科和成人再入院文献的审查，以及定性访谈的结果。我们将使用这些结果并评估干预措施的存在与目标1中风险调整后的再住院率之间是否存在关联。这三个目标将为医院在儿科哮喘再住院率方面的差异以及帮助预防这些变化的可能干预措施提供重要的见解。一个多学科指导委员会，其专长横跨质量评估和改进(Dudley博士和奥尔巴赫博士)、哮喘和卫生服务研究(Cabana博士)以及定性和定量研究(Halpern-Felsher博士和Dudley博士)等相关学科，将指导研究议程的进展。他们的指导，以及由K23奖项推动的重点培训和研究计划，将发展我在儿科护理质量研究方面的专业知识，重点是儿科再入院。这一教育和研究议程将使我能够实现我的目标，即制定一个全国受尊敬的研究计划，以提高儿科住院护理的质量，同时促进NICHD的使命，即确保所有儿童都有机会充分发挥他们的潜力，过上健康和富有成效的生活。