The ED.TRAUMA Study: Evaluating the Discordance ofTrauma Readmission And Unanticipated Mortality in the Assessment of hospital quality

ED.TRAUMA 研究：评估医院质量评估中创伤再入院和意外死亡率的不一致

• 批准号: 9911664
• 负责人: Cheryl K Zogg
• 金额: $ 2.98万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2023-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9911664
• 关键词: Accounting; Admission activity; Adult; Adverse event; Affect; Benchmarking; Caring; Communities; Complex; Data; Development; Educational process of instructing; Elderly; Event; Face; Fee-for-Service Plans; Foundations; Future; Grant; Health; Health Policy; Healthcare; Hip Fractures; Hospital Costs; Hospital Mortality; Hospitals; Life Expectancy; Measures; Medicare; Methodology; Methods; Modeling; Movement; National Health Policy; Nursing Homes; Operative Surgical Procedures; Outcome; Patients; Pattern; Performance; Population; Procedures; Provider; Quality of Care; Recovery; Reporting; Research; Resources; Risk; Severities; Standardization; Students; Time; Trauma; Trauma patient; Traumatic Brain Injury; Traumatic injury; United States; Variant; Visit; Work; adverse outcome; base; care outcomes; clinical care; cost; functional disability; high risk; hospital readmission; human old age (65+); improved; improved outcome; indexing; injured; mortality; trauma care

PROJECT SUMMARY/ABSTRACT Trauma is a common, high-risk, and high-cost condition that uniquely affects the health of older adults. In 2017 alone, 4.8 million non-fatal traumatic injuries were reported among older adults aged ≥65 years in the United States (US), costing hospitals and payers upwards of $66.8 billion (2019 USD) or ~2% of all US spending on healthcare. By 2050, the number of older adults is projected to rise to 89 million (22.1% of the total US population). With it is expected to come a parallel increase in the number of older adult trauma patients. Traumatic brain injury (TBI) and hip fracture are among the most common and debilitating forms of trauma encountered among older adults, often resulting in long-term functional impairments, nursing home admission, decreased independence, and shortened life expectancy. Improving outcomes for older trauma patients, particularly those with severe TBI and hip fracture, is an important national priority. While external benchmarking has evolved as the preeminent methodology used to compare hospital outcomes when measuring quality of care, its application among trauma patients is currently limited by a lack of available post-discharge data and concerns within the trauma community that poorly applied metrics might not be representative of the complex patients that trauma providers treat and the breadth of adverse outcomes that trauma patients face. Through this grant and its three specific aims, we propose to build on existing efforts within trauma to benchmark hospitals. Expanding on data currently limited to in-hospital mortality, we will utilize longitudinal 100% Medicare fee-for-service claims to study post-discharge outcomes among older adults hospitalized for: 1) trauma in general, 2) severe TBI, and 3) hip fracture. Aim 1. To quantify the extent of variability in and potential discordance between trauma mortality and readmission performance profiles. Aim 2. To ascertain whether there are clusters of hospitals with highly similar and/or highly divergent trauma readmission and mortality outcomes and identify associated factors. Aim 3. To compare the results of conventional external benchmarking for readmission with those attained under a model that allows for competing risk. The findings from this work will lay a foundation on which the continued development of trauma quality improvement and national health policy benchmarking can build. It will have a major, direct impact on how the quality of care for older adults is measured and conceptualized, helping to determine the future of clinical care for one of the most common, high-risk, and high-cost conditions affecting the health of older adults while simultaneously informing the development of meaningful and strong quality metric models with applications to both trauma and other non-trauma conditions.

项目总结/摘要 创伤是一种常见的，高风险和高成本的条件，独特地影响老年人的健康。2017年 仅在美国，年龄≥65岁的老年人中就报告了480万例非致命性创伤性损伤。 各州（美国），花费医院和支付者超过668亿美元（2019年美元），约占美国所有医疗支出的2% 健康护理到2050年，老年人的数量预计将上升到8900万（占美国总人口的22.1 人口）。预计老年创伤患者的数量也会相应增加。 创伤性脑损伤（TBI）和髋部骨折是最常见的和使人衰弱的创伤形式 在老年人中遇到的，往往导致长期的功能障碍，疗养院入院， 独立性下降，预期寿命缩短。改善老年创伤患者的预后， 特别是那些严重的创伤性脑损伤和髋部骨折的人，是一个重要的国家优先事项。 虽然外部基准已经发展成为用于比较医院结果的卓越方法 在衡量护理质量时，由于缺乏可用的 出院后的数据和创伤社区内的担忧，即应用不当的指标可能不会 创伤提供者治疗的复杂患者的代表性以及 患者面对的创伤通过这笔赠款及其三个具体目标，我们建议在现有努力的基础上， 基准医院的创伤。扩展目前仅限于住院死亡率的数据，我们将利用 纵向100%医疗保险按服务收费索赔，以研究老年人出院后的结果 住院原因：1）一般创伤，2）严重TBI，3）髋部骨折。目标1。为了量化变异的程度 创伤死亡率和再入院表现之间的潜在不一致性。目标二。到 确定是否有医院集群具有高度相似和/或高度不同的创伤再入院 和死亡率结果，并确定相关因素。目标3。为了比较常规外部的结果， 重新接纳的基准与那些在考虑到竞争风险的模式下获得的基准。 本研究的发现将为创伤质量的持续发展奠定基础 改进和建立国家卫生政策基准。它将对如何在一个重要的，直接的影响， 对老年人的护理质量进行测量和概念化，有助于确定临床护理的未来 对于影响老年人健康的最常见，高风险和高成本的条件之一， 同时通知有意义的和强大的质量度量模型的发展与应用， 创伤和其他非创伤条件。