Evaluating the safety and effectiveness of pediatric direct admissions to hospital

 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生和儿科学助理教授。她的目标是成为一名独立的临床研究员和住院儿童护理方面的全国领导者，专注于在提供以患者为中心的护理的同时提高医疗效率。Leyenaar博士提出的职业发展计划包括在高级统计学、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博士的导师团队将以患者为中心的结果研究方面的专业知识纳入比较有效性框架，指导她的职业发展。林德诺博士是首席导师，是一位成就卓著的研究人员，在指导调查人员走向独立研究职业生涯方面有着既定的记录。Leyenaar博士的工作环境非常支持她的成功，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，产生的总成本为206亿美元。这些儿童大部分是通过急诊科入院。对于身体状况稳定的儿童，直接入院是另一种方法，即转介到医院，而不在医院的急诊室接受护理。对于能够及时获得门诊医疗服务提供者的儿童，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ED量，以及降低医疗成本。然而，直接入院的潜在风险包括初始评估和管理的延迟，这可能会对患者安全造成不利影响。Leyenaar博士的研究目标是确定促进安全有效的直接入院的儿科人口、医疗保健环境和程序。她将通过以下方式实现这一目标：(1)比较直接入院和急诊就诊的常见临床情况的结果；(2)分析直接入院过程中利益相关者的观点；(2)制定以共识为导向的指南，并确定直接入院的安全和质量指标；以及(3)试行测试实施这一直接入院指南的可行性和可接受性。目标1将使用一个大型行政数据库对在美国结构多样化的医院住院的儿童进行回顾性队列研究，开发先进的统计模型来比较直接入院的儿童和通过急救系统入院的儿童的结果。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，随后将通过德尔福程序制定直接的入学指南并确定质量指标的优先顺序。目标3将涉及在以下方面实施这一准则 一家医院六个月，产生对后续研究和Leyenaar博士成为独立调查员至关重要的数据。

 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.