The Value of Pediatric Readiness in the Emergency Care of Injured Children

儿科准备在受伤儿童紧急护理中的价值

• 批准号: 9208558
• 负责人: Craig D. Newgard
• 金额: $ 58.96万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9208558
• 关键词: Accident and Emergency department; Accidental Injury; Accreditation; Acute; Address; Affect; American College of Surgeons; Area; Caring; Cause of Death; Child; Child Care; Childhood; Childhood Injury; Cohort Analysis; Communities; Complex; Contingent Negative Variation; Data; Data Set; Data Sources; Decision Analysis; Emergency Care; Emergency Situation; Emergency medical service; Engineering; Enrollment; Environment; Equilibrium; Equipment; Event; Geographic Locations; Goals; Health; Health Policy; Health system; Healthcare Systems; Hospitals; Injury; Injury Severity Score; Inpatients; Institute of Medicine (U.S.); Investigation; Life; Link; Measures; Outcome; Outcome Measure; Participant; Patient risk; Patient-Focused Outcomes; Patients; Policies; Policy Maker; Provider; Public Health; Quality of Care; Readiness; Reporting; Research; Research Design; Research Personnel; Resources; Science; System; Testing; Time; Trauma; Trauma Research; United States; big biomedical data; care seeking; care systems; cohort; cost; cost effective; data resource; demographics; high risk; improved; injured; multidisciplinary; novel; patient oriented; pediatric department; pediatric trauma; policy implication; population based; programs; repository; trauma care; trauma centers; years of life lost

Proposed Approach: We will develop a novel 24-state cohort of injured children presenting to emergency departments (EDs) over an 8-year period. We will then use this research data resource and an inter- disciplinary team to describe and evaluate the value of “pediatric readiness” in the emergency care of injured children. Importance: Unintentional injury remains the leading cause of death and years of potential life lost in children. Use of emergency services following injury is common, with large variability in the readiness to care for injured children. While several national and state efforts have sought to improve pediatric readiness, it remains unclear whether increased readiness improves quality and health outcomes, and at what cost. This project seeks to build a unique data resource for the scientific community and to use this resource and an inter-disciplinary team to rigorously evaluate the emergency care system for injured children in terms of quality, outcomes and costs. This project will fill key scientific gaps in pediatric trauma care and seeks to identify a re-engineered, high-value emergency care system for injured children that optimizes quality, outcomes and costs. Objectives: The proposal has 3 specific aims: Specific Aim 1. To build a novel 24-state research data resource and use these data to describe and quantify the emergency care of injured children in the context of pediatric readiness, including out-of-hospital, ED and inpatient care. Specific Aim 2. To evaluate how pediatric readiness affects the quality of care, health outcomes and costs of care for injured children. Specific Aim 3. To assess the value of pediatric readiness in the emergency care of injured children, including the balance of quality, outcomes and costs. Study Design: This will be a cohort analysis of a 24-state, population-based cohort of injured children presenting to 2,280 EDs in 24 states. Nine unique data sources will be matched at the patient level to create the master dataset. “Pediatric readiness” will be defined using a variety of EMS, ED and hospital measures. Setting: The setting includes 2,280 hospitals in 24 states, representing diverse facilities, geographic regions, patient demographics, pediatric readiness and systems of care. Participants: The study will enroll 21.6 million injured children 0 – 19 years presenting to 2,280 EDs following an injury event from 1/1/2012 through 12/31/2019, representing the entire denominator of injured children seeking emergency services in these states. The cohort will include 541,096 children with serious injuries (Injury Severity Score ≥ 16), representing high-risk patients. Outcome measures: We will evaluate 12 pediatric trauma quality measures, 2 patient-centered outcomes and acute care costs.

建议的方法：我们将开发一个新的 24 个州受伤儿童队列来接受紧急治疗 部门 (ED) 为期 8 年。然后，我们将使用该研究数据资源和内部 纪律小组描述和评估“儿科准备”在伤员紧急护理中的价值 孩子们。 重要性：意外伤害仍然是儿童死亡和潜在寿命损失的主要原因。 受伤后使用紧急服务很常见，但护理受伤人员的准备情况存在很大差异 孩子们。尽管一些国家和州努力寻求提高儿科准备情况，但目前尚不清楚 增加准备是否可以改善质量和健康结果，以及代价是什么。该项目旨在 为科学界建立独特的数据资源，并利用该资源和跨学科 团队从质量、结果和方面严格评估受伤儿童的紧急护理系统 成本。该项目将填补儿科创伤护理方面的关键科学空白，并寻求重新设计、 针对受伤儿童的高价值紧急护理系统，可优化质量、结果和成本。 目标：该提案有 3 个具体目标： 具体目标 1. 构建新颖的 24 州研究数据资源并使用这些数据进行描述和量化 在儿科准备情况下对受伤儿童进行紧急护理，包括院外、急诊室和 住院护理。 具体目标 2. 评估儿科准备情况如何影响护理质量、健康结果和费用 照顾受伤的儿童。 具体目标 3. 评估儿科准备情况在受伤儿童紧急护理中的价值，包括 质量、成果和成本的平衡。 研究设计：这将是对 24 个州的受伤儿童群体进行的队列分析 向 24 个州的 2,280 名急诊室进行演示。将在患者级别匹配九个独特的数据源以创建 主数据集。 “儿科准备”将使用各种 EMS、ED 和医院措施来定义。 背景：该背景包括 24 个州的 2,280 家医院，代表不同的设施、地理区域、 患者人口统计、儿科准备情况和护理系统。 参与者：该研究将招募 2,160 万名 0 至 19 岁受伤儿童，随后向 2,280 名急诊室就诊 2012年1月1日至2019年12月31日期间发生的伤害事件，代表受伤儿童的全部分母 在这些州寻求紧急服务。该队列将包括 541,096 名受重伤的儿童 （损伤严重程度评分≥16），代表高危患者。 结果衡量标准：我们将评估 12 项儿科创伤质量衡量标准、2 项以患者为中心的结果以及 急性护理费用。