The Value of Emergency Care For Injured Older Adults

紧急护理对受伤老年人的价值

• 批准号: 9249479
• 负责人: Craig D. Newgard
• 金额: $ 25万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9249479
• 关键词: Value; Emergency; Care; Injured; Older

 DESCRIPTION (provided by applicant): We will build on a previously collected prospective cohort of injured older adults accessing 911 emergency medical services (EMS) in 7 counties by matching to pre-/post-injury Medicare data, state trauma registries, state discharge data and end-of-life preferences. We will then evaluate the value of emergency care for injured older patients using long-term outcomes, resource use and costs. Importance: Current EMS triage practices fail to identify many older adults with serious injuries, resulting in transport to non-trauma hospitals (under-triage) and potentially worse outcomes. Under-triage is counter- balanced by over-triage (transport of patients with minor injuries to major trauma centers), which results in unnecessary costs, disruptions in care and no measureable benefit. However, there is little research to describe and understand these issues, particularly in older adults. This project will rigorously address EMS triage practices unique to older adults, including the role of comorbidities, medication use, end-of-life preferences, functional survival, resource use and costs. We will also validate new triage guidelines to better identify seriously injured older adult and compare to current triage practices. This project will fill key scientific gaps and inform the next revision of national EMS triage guidelines. Objectives: The proposal has 3 specific aims: Specific Aim 1. Describe the current emergency care system for injured older adults, including out-of-hospital triage processes, reasons for selecting hospitals, short- and long-term outcomes, resource use, and costs. Specific Aim 2. Refine and validate a previously derived out-of-hospital risk stratification tool to better identify seriously injured older adults that could be incorporatd into national triage guidelines. Specific Aim 3. Estimate the overall programmatic impact (benefits, harms and costs) of triage guidelines from Aim 2, compared to current triage guidelines. Study Design: This will be a secondary analysis of a 7-county, population-based, prospective EMS cohort, matched to pre- and post-injury Medicare data, two state trauma registries, two state discharge databases and the Oregon Physician Orders for Life-Sustaining Treatment (POLST) registry. Setting: The setting includes 7 counties in Oregon and Washington (urban, suburban and rural regions), 44 EMS agencies and 44 acute care hospitals (4 major trauma centers and 40 non-tertiary hospitals). Participants: The study will include 17,909 injured adults = 65 years transported by EMS to 44 hospitals between 1/1/2011 - 12/31/2011, representing the denominator of older adults to whom the field triage guidelines are applied. Patients with serious injuries (Injury Severity Score = 16) will define high-risk patients. Outcome measures: Outcomes will include 1-year functional survival, resource use (repeat EMS transports, repeat ED visits and re-admissions), and health care costs up to 1-year post-injury.

 描述（由申请人提供）：我们将基于之前收集的 7 个县接受 911 紧急医疗服务 (EMS) 的受伤老年人前瞻性队列，通过匹配受伤前/受伤后医疗保险数据、州创伤登记、州出院数据和临终偏好。然后，我们将利用长期结果、资源使用和成本来评估老年受伤患者紧急护理的价值。重要性：目前的 EMS 分诊实践未能识别出许多患有严重损伤的老年人，导致被送往非创伤医院（分诊不足）并可能导致更糟糕的结果。分诊不足与过度分诊（将轻伤患者运送到主要创伤中心）相抵消，这会导致不必要的成本、护理中断并且没有可衡量的益处。然而，很少有研究来描述和理解这些问题，特别是对于老年人。这个项目 将严格解决老年人特有的 EMS 分诊实践，包括合并症的作用、药物使用、临终偏好、功能生存、资源使用和成本。我们还将验证新的分诊指南，以更好地识别严重受伤的老年人，并与当前的分诊做法进行比较。该项目将填补关键的科学空白，并为国家 EMS 分类指南的下一次修订提供信息。目标：该提案有 3 个具体目标： 具体目标 1. 描述当前针对受伤老年人的紧急护理系统，包括院外分诊流程、选择医院的原因、短期和长期结果、资源使用和成本。具体目标 2. 完善和验证先前得出的院外风险分层工具，以更好地识别严重受伤的老年人，并将其纳入国家分诊指南。具体目标 3. 与当前的分类指南相比，评估目标 2 中的分类指南的总体计划影响（效益、危害和成本）。研究设计：这将是对 7 个县、以人口为基础的前瞻性 EMS 队列的二次分析，与受伤前和受伤后的医疗保险数据、两个州创伤登记处、两个州出院数据库和俄勒冈州生命维持治疗医师医嘱 (POLST) 登记处相匹配。地点：地点包括俄勒冈州和华盛顿州的 7 个县（城市、郊区和农村地区）、44 个 EMS 机构和 44 家急症护理医院（4 个主要创伤中心和 40 个非三级医院）。参与者：该研究将包括2011年1月1日至2011年12月31日期间由EMS运送到44家医院的17,909名受伤成年人（65岁），代表了现场分诊指南所适用的老年人的分母。严重损伤的患者（损伤严重程度评分 = 16）将被定义为高风险患者。结果 措施：结果将包括 1 年功能生存、资源使用（重复 EMS 转运、重复急诊室就诊和重新入院）以及受伤后 1 年内的医疗保健费用。