Effects of Ambulance, Transport Distance, and Hospital Destination on Health Outcomes of Out-of-Hospital Medical Emergencies

救护车、运输距离和医院目的地对院外医疗紧急情况健康结果的影响

• 批准号: 9425588
• 负责人: Prachi Sanghavi
• 金额: $ 39.39万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-08 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9425588
• 关键词: Effects; Ambulance; Transport; Distance; Hospital

Pre-hospital care plays a crucial role in determining health outcomes after trauma and out-of-hospital complications of other leading causes of death, such as stroke and heart disease. Yet, it has largely been neglected by the scientific community, leaving assumptions rather than evidence to guide policy decisions on the ambulance type and hospital destination that would optimize a patient’s health outcomes. In previous work, our team compared two competing strategies for delivering emergency ambulance care, advanced life support (ALS) and basic life support (BLS), and found that ALS, which is much more common in the United States, may be less successful in keeping patients alive and as well as possible. In this work, we studied several out-of- hospital medical emergencies using quasi-experimental research methods and a large national sample of Medicare claims from 2006-2011. In our first aim of the proposed work, we will extend this analysis to the under 65 adult Medicaid population, which is particularly important to do for major trauma as younger people sustain different patterns of injury than older adults. In addition to major trauma, we will also study out-of-hospital cardiac arrest, stroke, respiratory failure, and acute myocardial infarction, all of which are time sensitive conditions requiring prompt medical care. The next aim will build upon this and our previous work and analyze choice of hospital destination for ALS and BLS patients. To date, regionalization studies that evaluate outcomes of out-of- hospital medical emergencies at specialty hospitals like trauma centers rarely account for the amount of time spent in pre-hospital care, which is influenced by whether that care was provided by ALS or BLS, or adequately study the trade-off between minimizing travel distance and optimizing hospital characteristics. We will improve upon the existing literature using Medicare and Medicaid claims, regression analysis, and causal inference methods to study the associations and causal relationships between these key factors and survival. To describe the broad implications of our findings, in our third aim we will quantify the potential benefits at the national level of optimizing individual pre-hospital care decisions based on existing resources using a microsimulation model. Finally, for longer-term policymaking, we will assess how shifts in ambulance resources and hospital locations in four states might affect population health outcomes for out-of-hospital medical emergencies. The proposed work will advance safety and quality research for the pre-hospital care system and hospital regionalization and will fill critical gaps in the scientific literature. We expect to provide specific, evidence-based insights that policymakers can use to substantially improve pre-hospital and hospital care for out-of-hospital medical emergencies. Importantly, our use of Medicaid claims and focus on trauma care will be particularly relevant to inner-city, low-income, and minority populations.

院前护理在确定创伤后和院外的健康结果方面起着至关重要的作用 其他主要死因的并发症，如中风和心脏病。然而，它在很大程度上 被科学界忽视，留下假设而不是证据来指导政策决定， 救护车类型和医院目的地，将优化病人的健康结果。在以前的工作中， 我们的团队比较了两种相互竞争的策略， (ALS)和基本生命支持（BLS），并发现在美国更常见的ALS可能 在维持病人的生命和尽可能好的方面不太成功。在这项工作中，我们研究了几个外- 医院医疗急救使用准实验研究方法和一个大的国家样本， 2006年至2011年的医疗保险索赔。在我们提出的工作的第一个目标中，我们将把这种分析扩展到 65成人医疗补助人口，这是特别重要的是要做的重大创伤，因为年轻人维持 与老年人不同的伤害模式。除了重大创伤，我们还将研究院外心脏 心脏骤停、中风、呼吸衰竭和急性心肌梗死，所有这些都是时间敏感性疾病 需要及时的医疗护理。下一个目标将建立在这一点和我们以前的工作，并分析选择 ALS和BLS患者的医院目的地。到目前为止，评价非区域化成果的区域化研究， 像创伤中心这样的专科医院的医院医疗紧急情况很少占时间的量 花费在院前护理上，这取决于护理是由ALS还是BLS提供的，还是充分的 研究最小化旅行距离和优化医院特征之间的权衡。完善 基于现有文献，使用医疗保险和医疗补助索赔，回归分析和因果推理 方法来研究这些关键因素和生存之间的关联和因果关系。来描述 我们的研究结果的广泛影响，在我们的第三个目标，我们将量化在国家一级的潜在利益 利用微观模拟模型，基于现有资源优化个人院前护理决策。 最后，为了更长期的政策制定，我们将评估救护车资源和医院地点的变化 在四个州，这可能会影响医院外医疗紧急情况的人口健康结果。拟议 工作将推进院前护理系统和医院区域化的安全和质量研究， 将填补科学文献中的重要空白。我们希望提供具体的、基于证据的见解， 政策制定者可以用来大幅改善院前和院外医疗护理， 突发事件重要的是，我们对医疗补助索赔的使用和对创伤护理的关注将特别相关， 低收入和少数民族人口。