Organizational Interventions for SSI Prevention in Pediatric Spinal Surgery

小儿脊柱手术中 SSI 预防的组织干预

• 批准号: 9281647
• 负责人: Lisa M. McLeod
• 金额: $ 24.9万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2019-02-23
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9281647
• 关键词: Organizational; Interventions; SSI; Prevention; Pediatric

PROJECT SUMMARY/ABSTRACT Dr. McLeod, MD, MSCE is a junior investigator in pediatric hospital medicine with advanced training in clinical epidemiology and quantitative analyses. Her research is focused on the comparative effectiveness of interventions for preventing surgical site infections (SSI) following spinal fusion operations in children, with an emphasis on the association between elements of the organizational contexts of care and patient-centered outcomes. In the K99 portion of this proposal, Dr. McLeod describes a multi-disciplinary career development program that will build on her existing skills and will provide advanced training in qualitative and mixed method research, quasi-experimental study designs, and implementation science, all of which will be instrumental to her future success as an independent health services investigator focused on the improvement of patient- centered outcomes in children hospitalized with complex medical and surgical conditions. The K99 research plan outlined in Aim 1 will use quantitative and qualitative methods to explore hospital-specific organizational factors that distinguish high versus low performance in SSI prevention (as determined by adjusted rates of SSI). In addition to providing Dr. McLeod with mentorship and rigorous training in mixed method research, completion of this project will generate hypotheses about organizational barriers and facilitators to the effective implementation of SSI prevention practices. These findings will then serve as the foundation for the R00 proposal (Aim 2) to independently execute a multi-center trial comparing the effectiveness of existing implementation strategies at low performing hospitals to the effectiveness of a tailored (informed by Aim1 barriers/facilitators), multi-disciplinary approach to designing, implementing, and evaluating a patient-focused and patient-informed intervention to reduce SSIs and the preventable harms resulting from them. Applying the skills and training acquired during the K99 phase, this trial will use a novel mixed method approach that addresses limitations in prior research by (1) allowing for the exploration of contextual factors that are not readily measured using quantitative methods alone, and (2) involving at all stages family perspectives on barriers and facilitators to improving quality and outcomes of care for their children. To accomplish her transition, Dr. McLeod has assembled an outstanding team of mentors led by Ron Keren, MD, MPH and renowned orthopaedic surgeon, John Dormans, MD, and will continue to benefit from the rich resources offered by the University of Pennsylvania and Children's Hospital of Philadelphia. Importantly, this research will serve as a proof-of-concept for the use of comprehensive patient-focused strategies for improving the implementation effectiveness of interventions to prevent complications following surgical procedures in children, and will inform future multi-center trials to operationalize and test these strategies at other hospitals and for other conditions.

项目总结/摘要 博士McLeod，MD，MSCE是儿科医院医学的初级研究员，接受过临床高级培训 流行病学和定量分析。她的研究重点是 预防儿童脊柱融合术后手术部位感染（SSI）的干预措施， 强调护理和以病人为中心的组织背景的元素之间的关联 结果。在本提案的K99部分，McLeod博士描述了多学科的职业发展 该计划将以她现有的技能为基础，并提供定性和混合方法的高级培训 研究，准实验研究设计和实施科学，所有这些都将有助于 她未来作为一名独立的卫生服务调查员的成功集中在改善病人的健康， 以复杂内科和外科疾病住院儿童的结局为中心。 目标1中概述的K99研究计划将使用定量和定性方法来探索 医院特有的组织因素，区分高与低性能的SSI预防（如 调整后的SSI比率）。除了为麦克劳德博士提供指导和严格的培训外 在混合方法研究中，完成本项目将产生关于组织障碍的假设 有效实施SSI预防措施的促进者。 这些发现将作为R 00提案（目标2）独立执行的基础 一项多中心试验，比较了现有实施策略在低绩效下的有效性 医院的有效性，一个定制的（由目标1障碍/促进者告知），多学科的方法， 设计、实施和评估以患者为中心、患者知情的干预措施，以减少SSI 以及由此产生的可预防的危害。 应用K99阶段获得的技能和培训，本试验将使用一种新颖的混合方法 一种解决先前研究局限性的方法：（1）允许探索背景因素 不容易单独使用定量方法测量，以及（2）涉及所有阶段的家庭 对提高儿童照料质量和成果的障碍和促进因素的看法。 为了完成她的转变，麦克劳德博士组建了一个由罗恩领导的优秀导师团队 Keren，医学博士，公共卫生硕士和著名的整形外科医生，John Dormans，医学博士，并将继续受益于 宾夕法尼亚大学和费城儿童医院提供的丰富资源。重要的是， 这项研究将作为使用全面的以患者为中心的策略的概念验证， 提高干预措施的实施效果，以预防手术后并发症 在儿童中的程序，并将告知未来的多中心试验，以操作和测试这些策略， 其他医院和其他条件。

项目成果

The Use of Individual Provider Performance Reports by US Hospitals.

• DOI: 10.12788/jhm.2922
• 发表时间: 2018-08-01
• 期刊: Journal of hospital medicine
• 影响因子: 2.6
• 作者: Rolnick JA;Ryskina KL
• 通讯作者: Ryskina KL

Variation in 60-day Readmission for Surgical-site Infections (SSIs) and Reoperation Following Spinal Fusion Operations for Neuromuscular Scoliosis.

神经肌肉脊柱侧凸脊柱融合手术后 60 天因手术部位感染 (SSI) 再入院和再次手术的变化。

• DOI: 10.1097/bpo.0000000000000495
• 发表时间: 2016
• 期刊: Journal of pediatric orthopedics
• 作者: McLeod,Lisa;Flynn,John;Erickson,Mark;Miller,Nancy;Keren,Ron;Dormans,John
• 通讯作者: Dormans,John

Collaborations with Pediatric Hospitalists: National Surveys of Pediatric Surgeons and Orthopedic Surgeons.

与儿科住院医生的合作：全国儿科外科医生和整形外科医生调查。

• DOI: 10.12788/jhm.2921
• 发表时间: 2018
• 期刊: Journal of hospital medicine
• 影响因子: 2.6
• 作者: Rosenberg,RebeccaE;Abzug,JoshuaM;Rappaport,DavidI;Mazziotti,MarkV;Shrader,MWade;Zipes,David;Nwomeh,Benedict;McLeod,Lisa
• 通讯作者: McLeod,Lisa