Explaining Variation in Mortality after Pediatric Cardiac Surgery

解释小儿心脏手术后死亡率的变化

• 批准号: 8829068
• 负责人: Michael Gaies
• 金额: $ 13.23万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8829068
• 关键词: Acute; Address; Adult; Canada; Cannulations; Cardiac; Cardiac Surgery procedures; Cardiovascular Diseases; Caring; Cessation of life; Characteristics; Child; Child Care; Child Mortality; Childhood; Chronology; Clinical; Common Ventricle; Complex; Complication; Congenital Abnormality; Congenital Heart Defects; Critical Care; Data; Data Element; Data Set; Databases; Educational Grants; Environment; Epidemiology; Event; Failure; Goals; Health; Health Services Accessibility; Heart Diseases; Heart failure; Hospital Mortality; Hospitals; Incidence; Institution; Intensive Care Units; International; Intervention; Learning; Link; Low Cardiac Output Syndrome; Measures; Medicine; Mentorship; Monitor; Near-Infrared Spectroscopy; Nursing Staff; Operative Surgical Procedures; Outcome; Outcomes Research; PC4 Gene; Patient-Focused Outcomes; Patients; Pattern; Pediatric Surgical Procedures; Performance; Perioperative; Perioperative Care; Physicians; Postoperative Period; Procedures; Process; Quality of Care; Registries; Research; Research Personnel; Research Proposals; Research Training; Resources; Scientist; Seminal; Services; Specialist; Statistical Methods; Structure; System; Systems Analysis; Techniques; Tetralogy of Fallot; Time; Training; Translating; Transposition of Great Vessels; United States; Variant; Vulnerable Populations; base; career; career development; clinical epidemiology; clinical practice; congenital heart disorder; data sharing; design; evidence base; experience; implementation science; improved; innovation; interest; mortality; multidisciplinary; operation; programs; response; skills; ward; young adult

DESCRIPTION (provided by applicant): Outcomes research has demonstrated that the quality of pediatric surgical care varies across centers in the United States. Understanding the key drivers of this variation and ultimately how to improve care are critical questions facing clinicia-scientists in pediatric cardiac critical care and cardiac surgery. This proposal seeks to elucidate the underlying reasons for variation in quality of care after pediatric cardiac surgery while providing the career development candidate with a very rich research training and mentorship experience. The research proposal focuses specifically on perioperative mortality for the 20,000 children and young adults who require surgery for pediatric and congenital heart disease each year. Variation in outcomes between hospitals suggests opportunities to reduce potentially avoidable deaths in this vulnerable population. The proposal's research aims include (1) determining the clinical epidemiology of perioperative mortality and the cause- specific mortality that drives variation in hospital performance; (2) analyzing the system and organizational factors that associate with better outcomes; and (3) determining the specific processes of care that underlie hospital performance. This project, the multidisciplinary mentorship team, and the research environment are ideally suited to address the career goals and educational needs of the candidate, Michael G. Gaies, MD, MPH. Dr. Gaies is a board-certified pediatric cardiologist with clinical and scientific interests in patient-centered outcomes research in the pediatric cardiac intensive care unit setting. His prior research experience in studying pediatric cardiac surgical outcomes and interventions to optimize cardiac critical care has prepared him for this proposal. However, he will need additional training to achieve his career goal of improving perioperative care via an international quality-improvement consortium. His educational goals to develop expertise in advanced statistical methods for comparing hospital performance and implementation science are feasible as described in the grant's educational plan with the assistance of his highly accomplished mentorship team. The educational program includes graduate-level coursework, structured seminars, project-based learning, and interaction with international experts in measuring the quality of surgical care. In summary, this research proposal, mentorship team, educational plan, and the overall institutional environment will lay the groundwork for Dr. Gaies to become an innovative, independent scientist capable of translating his findings into improved care for children with critical cardiovascular disease.

描述（由申请人提供）：结果研究表明，美国各个中心的儿科手术护理质量各不相同。了解这种变化的关键驱动因素以及最终如何改善护理是儿科心脏重症监护和心脏外科临床科学家面临的关键问题。该提案旨在阐明 儿科心脏手术后护理质量变化的根本原因，同时为职业发展候选人提供非常丰富的研究培训和指导经验。该研究提案特别关注每年 20,000 名因儿科和先天性心脏病需要接受手术的儿童和年轻人的围手术期死亡率。医院之间的结果差异表明，有机会减少这一弱势群体中本来可以避免的死亡。该提案的研究目标包括（1）确定围手术期死亡率的临床流行病学以及导致医院绩效变化的特定原因死亡率； (2) 分析与更好结果相关的系统和组织因素； (3) 确定构成医院绩效的具体护理流程。该项目、多学科导师团队和研究环境非常适合解决候选人 Michael G. Gaies（医学博士、公共卫生硕士）的职业目标和教育需求。 Gaies 博士是一位经过委员会认证的儿科心脏病专家，对儿科心脏重症监护病房环境中以患者为中心的结果研究具有临床和科学兴趣。他之前在研究儿科心脏手术结果和优化心脏重症监护的干预措施方面的研究经验为他的这一提议做好了准备。然而，他将需要额外的培训，以实现通过国际质量改进联盟改善围手术期护理的职业目标。他的教育目标是发展先进统计方法方面的专业知识，以比较医院绩效和实施科学，这在他卓有成就的导师团队的帮助下，如赠款教育计划中所述是可行的。教育计划包括研究生水平的课程、结构化研讨会、基于项目的学习以及与国际专家在衡量外科护理质量方面的互动。总之，这项研究计划、指导团队、教育计划和整体机构环境将为盖斯博士成为一名创新、独立的科学家奠定基础，使他能够将他的发现转化为改善对患有严重心血管疾病的儿童的护理。