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博士的导师团队在比较有效的框架中带来了以患者为中心的成果研究方面的专业知识，指导她的职业发展。Lindenauer博士，主要导师，是一位有成就的调查员，在指导调查员走向独立的研究生涯方面有着良好的记录。Leyenaar博士在一个非常支持她成功的环境中工作，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，总费用为206亿美元。这些儿童大多数是通过急诊科（艾德）入院的。对于病情稳定的儿童，直接入院是一种替代方法，包括转诊到医院，而无需在医院的ED接受治疗。在及时获得门诊医疗服务的儿童中，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，减少艾德量，并降低医疗费用。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产生不利影响。Leyenaar博士的研究目标是确定儿科人群，医疗机构和程序，以促进安全有效的直接入院。她将通过以下方式实现这一目标：（1）比较常见临床条件下直接入院和艾德入院的结果;（2a）描述直接入院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性和质量指标;（3）对实施该直接入院指南的可行性和可接受性进行试点测试。目标1将使用大型管理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，以比较直接入院儿童与通过ED入院儿童的结局。目标2将通过让父母、医疗保健提供者、支付者和政策制定者参与关于其入院经验和观点的审议性讨论来实现，然后通过德尔菲程序来制定直接的入院指南并优先考虑质量指标。目标3将涉及在以下方面实施这一准则： 在一家医院进行了六个月的研究，产生了对后续研究至关重要的数据，并使Leyenaar博士成为一名独立的研究者。

 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.