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

 描述（由申请人提供）：这个K 08奖将使候选人，科里L。Sauser，医学博士，理学硕士，成为一名独立的医生科学家，专注于急性卒中护理系统，专门致力于提高证据翻译的效率， 来改善病人的治疗效果急性缺血性卒中很常见，但不同医院对卒中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少残疾的治疗;这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更好地了解美国医院在提供急性卒中护理方面的组织情况，方法是创建美国卒中医院转移网络地图，然后使用该地图确定绩效和高质量护理如何在连接的医院之间传播。为了实现这些目标，该提案包括一个综合课程，包括密集的辅导和网络分析方法，先进的统计建模，组织文化和实施研究的教学课程。她的发展和培训活动还包括建立一个研究网络，与区域中风网络的利益相关者接触，并参加国家科学会议。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，这些领导人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建模方面具有专业知识。Sauser博士将利用一个链接数据集，该数据集包含与指南-卒中临床登记相关的医疗保险索赔，以创建美国急性缺血性卒中转移网络的地图。有了这张地图，她将：1）描述与急性缺血性卒中患者转院目的地选择相关的因素（如感知的医院质量）; 2）检查通过频繁转院患者连接的医院是否具有更相似的急性卒中护理提供的性能和质量; 3）纵向检查这些网络关系，以了解网络中医院之间的性能和质量扩散。完成这个拟议的项目将产生一个美国中风网络的地图，并了解中风如何通过网络流动的最佳实践。这将有助于解释医院水平的质量差异，并为改善中风护理提供下一步的信息。完成拟议的项目和教学培训计划也将有助于Sauser博士过渡到一个独立的卫生服务调查员，专注于改善美国的中风护理服务。

 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.