Identifying novel system-level factors associated with the quality of acute stroke care delivery

识别与急性卒中护理服务质量相关的新系统级因素

• 批准号: 9333243
• 负责人: Korilyn Sauser Zachrison
• 金额: $ 15.8万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-16 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9333243
• 关键词: Identifying; novel; system; level; factors

 DESCRIPTION (provided by applicant): This K08 award will enable the candidate, Kori L. Sauser, MD, MSc, to become an independent physician scientist focused on acute stroke systems of care specifically dedicated to improving the efficiency of evidence translation in order to improve patient outcomes. Acute ischemic stroke is common, yet there is broad variation in the care of stroke patients between hospitals. Many eligible patients do not receive disability-�reducing treatment; this results in greater neurologic damage and long-­‐term disability for patients, and large societal costs. Dr. Sauser's proposed study aims to better understand the organization of U.S. hospitals in the delivery of acute stroke care by creating a map of the U.S. stroke hospital transfer network, and then using this map to determine how performance and high-­‐quality care are disseminated between connected hospitals. To achieve these goals, this proposal includes an integrated curriculum consisting of intensive mentorship and didactic coursework in network analysis methodology, advanced statistical modeling, and organizational culture and implementation research. Her development and training activities also include building a research network, engaging with stakeholders in regional stroke networks, and participating in national scientific meetings. The rich academic environment at Massachusetts General Hospital and Harvard University is ideal for Dr. Sauser's training and has enabled her to assemble a mentorship team of national leaders with expertise in stroke health services research, epidemiology, network analysis methodology, healthcare quality measurement, and advanced statistical modeling. Dr. Sauser will utilize a linked dataset containing Medicare claims linked with the Get with the Guidelines-­‐Stroke clinical registry to create a map of the U.S. acute ischemic stroke transfer network. With this map she will: 1) describe factors related to choice of hospital transfer destination for transferred acute ischemic stroke patients (such as perceived hospital quality); 2) examine whether hospitals that are connected by frequent transfer of patients have more similar performance and quality of acute stroke care delivery; and 3) longitudinally examine these network relationships to understand the diffusion of performance and quality between hospitals in the network. Completion of this proposed project will produce a map of the U.S. stroke network and an understanding of how best practices for stroke flow through the network. This will help explain variation in quality at the hospital level, and inform next steps for improving stroke care delivery. Completing the proposed project and didactic training plan will also facilitate Dr. Sauser's transition to an independent health services investigator focused on improving the delivery of stroke care in the U.S.

 描述（由申请人提供）：该 K08 奖项将使候选人 Kori L. Sauser，医学博士、理学硕士成为一名独立医师科学家，专注于急性中风护理系统，专门致力于提高证据翻译的效率，以便 以改善患者的治疗效果。急性缺血性中风很常见，但不同医院对中风患者的护理存在很大差异。许多符合条件的患者没有接受减残治疗；这会导致患者更大的神经损伤和长期残疾，以及巨大的社会成本。 Sauser 博士提出的研究旨在通过创建美国中风医院转移网络地图，然后使用该地图来确定如何在相连的医院之间传播绩效和高质量护理，从而更好地了解美国医院在提供急性中风护理方面的组织。为了实现这些目标，该提案包括一门综合课程，其中包括网络分析方法、高级统计建模以及组织文化和实施研究方面的强化指导和教学课程。她的发展和培训活动还包括建立研究网络、与区域中风网络的利益相关者合作以及参加国家科学会议。马萨诸塞州总医院和哈佛大学丰富的学术环境非常适合 Sauser 博士的培训，并使她能够组建一支由国家领导人组成的导师团队，他们在中风健康服务研究、流行病学、网络分析方法、医疗质量测量和高级统计模型方面拥有专业知识。 Sauser 博士将利用包含与 Get with theGuidelines-Stroke 临床登记处链接的医疗保险索赔的链接数据集来创建美国急性缺血性中风转移网络的地图。通过这张地图，她将：1）描述与转院的急性缺血性中风患者的医院转院目的地选择相关的因素（例如感知的医院质量）； 2) 检查因患者频繁转诊而相连的医院在急性卒中护理服务方面是否具有更相似的表现和质量； 3）纵向检查这些网络关系，以了解网络中医院之间绩效和质量的扩散情况。该拟议项目的完成将生成美国中风网络地图，并了解中风最佳实践如何通过网络流动。这将有助于解释医院层面的质量差异，并为改善中风护理服务的后续步骤提供信息。完成拟议的项目和教学培训计划也将有助于 Sauser 博士转型为独立健康服务调查员，专注于改善美国中风护理的提供。