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

建议的方法：我们将开发一个新的24个州的急诊受伤儿童队列 部门(EDs)，为期8年。然后，我们将使用此研究数据资源和一个内部 纪律小组将描述和评估“儿科准备状态”在伤员急救中的价值 孩子们。 重要：意外伤害仍然是导致儿童死亡和潜在寿命损失的主要原因。 在受伤后使用急救服务是很常见的，伤员护理的准备程度有很大的差异 孩子们。虽然几个国家和州的努力已经寻求改善儿科准备情况，但仍不清楚 提高就绪性是否会改善质量和健康结果，以及成本是多少。这一项目旨在 为科学界建立一个独特的数据资源，并利用这个资源和一个跨学科 小组严格评估受伤儿童紧急护理系统的质量、结果和 成本。该项目将填补儿科创伤护理方面的关键科学空白，并寻求确定一种重新设计的、 针对受伤儿童的高价值紧急护理系统，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.建立一个新的24州研究数据资源，并使用这些数据来描述和量化 在儿科准备情况下对受伤儿童的紧急护理，包括院外、急诊室和 住院治疗。 具体目标2.评估儿科准备情况如何影响保健质量、健康结果和费用 照顾受伤的儿童。 具体目标3.评估儿科准备在紧急护理受伤儿童方面的价值，包括 质量、结果和成本的平衡。 研究设计：这将是对24个州、以人群为基础的受伤儿童队列的队列分析 向24个州的2280名急救人员展示。将在患者级别匹配九个唯一的数据源，以创建 主数据集。将使用各种EMS、急诊和医院措施来定义“儿科准备就绪”。 环境：环境包括24个州的2280家医院，代表着不同的设施、地理区域、 患者人口统计、儿科准备情况和护理系统。 参与者：这项研究将招募2160万名0-19岁的受伤儿童，向2280名急救人员展示以下内容 2012年1月1日至2019年12月31日期间的受伤事件，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名严重受伤的儿童 (损伤严重程度评分≥16)，代表高危患者。 结果指标：我们将评估12项儿科创伤质量指标，2项以患者为中心的结果和 急性护理费用。

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.