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个州的受伤儿童队列， 在8年的时间里，部门（ED）。然后，我们将使用这个研究数据资源和一个内部- 一个学科小组来描述和评估"儿科准备"在受伤的紧急护理中的价值 孩子 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是常见的，在准备照顾受伤者方面存在很大的差异 孩子虽然几个国家和州的努力，以提高儿科准备，它仍然不清楚 提高准备程度是否会提高质量和健康结果，以及代价是什么。本项目谋求 为科学界建立一个独特的数据资源，并利用这一资源和跨学科的 小组严格评估受伤儿童的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的关键科学空白，并寻求确定一种重新设计的， 为受伤儿童提供高价值的紧急护理系统，优化质量、结果和成本。 目标：该提案有三个具体目标： 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、艾德和 住院治疗 具体目标2。评估儿科准备如何影响护理质量，健康结果和成本， 照顾受伤的孩子。 具体目标3。评估儿科准备在受伤儿童急诊护理中的价值，包括 质量、成果和成本的平衡。 研究设计：这将是一个队列分析的24个国家，人口为基础的队列受伤儿童 向24个州的2,280名ED展示。九个独特的数据源将在患者层面进行匹配， master数据集。将使用各种EMS、艾德和医院措施来定义"儿科准备"。 设置：该设置包括24个州的2,280家医院，代表不同的设施，地理区域， 患者人口统计学、儿科准备情况和护理系统。 参与者：该研究将招募2160万名0 - 19岁的受伤儿童， 2012年1月1日至2019年12月31日的伤害事件，代表受伤儿童的全部分母 在这些国家寻求紧急服务。该队列将包括541，096名严重受伤的儿童 （损伤严重度评分≥ 16），代表高风险患者。 结果测量：我们将评估12项儿科创伤质量测量，2项以患者为中心的结果， 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.