The Impact of Public Reporting on Procedural Outcomes Following Congenital Heart Surgery

公开报告对先天性心脏病手术后手术结果的影响

• 批准号: 10371685
• 负责人: Natalie Jayaram
• 金额: $ 17.15万
• 依托单位: CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-28 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371685
• 关键词: Adult; Advocate; Area; Behavior; Cardiac Surgery procedures; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caregivers; Caring; Case Mixes; Characteristics; Child; Child Care; Childhood; Cities; Clinical; Complex; Comprehension; Coupled; Data; Data Analyses; Data Reporting; Databases; Development Plans; Diagnosis; Disclosure; Effectiveness; Ensure; Face; Faculty; Family; Focus Groups; Goals; Health; Health Personnel; Health Services; Healthcare; Heterogeneity; Hospitals; Inpatients; Institution; Investigation; Kansas; Life; Light; Mentorship; Methodology; Methods; Missouri; Nature; Operative Surgical Procedures; Outcome; Outcome Assessment; Outcomes Research; Parents; Patient Preferences; Patient Selection; Patient-Focused Outcomes; Patients; Pattern; Pediatrics; Policies; Policy Maker; Process; Provider; Qualitative Research; Quality of Care; Reporting; Research; Research Personnel; Risk; Sample Size; Science; Severities; Site; Time; Training; Training and Education; Travel; Universities; Work; base; care outcomes; career; career development; clinical care; congenital heart disorder; data format; design; experience; high risk; improved; improved outcome; meetings; member; mortality; operation; patient engagement; pediatric cardiologist; pediatric department; pediatric patients; preference; pressure; professor; profiles in patients; programs; skills; social; surgery outcome

PROJECT SUMMARY/ABSTRACT Natalie Jayaram, MD MSB is an Assistant Professor of Pediatrics at the University of Missouri-Kansas City and a faculty member in the Department of Pediatrics and Division of Cardiology at Children’s Mercy Hospital in Kansas City, Missouri. As a pediatric cardiologist and health services researcher, her long-term career goals are to improve the care of pediatric patients with congenital heart disease (CHD) by contributing to the science of quality assessment, by examining the effectiveness of policy-based initiatives on care, and by partnering directly with patients to facilitate changes in care. The goal of the current project is to study public reporting for congenital heart surgery (CHS). Public reporting is designed to provide healthcare consumers with outcome data for a given provider or institution. Proponents of public reporting advocate for transparent disclosure of health outcomes data and contend that public reporting results in improved outcomes.1-4 Critics of public reporting cite evidence that public reporting may not substantially improve outcomes and could result in unintended consequences, including risk avoidance practices.5-14 Formal study regarding the impact of public reporting on outcomes for CHS has never been performed. The highly specialized nature of CHD care, with relatively less local or regional competition compared to more prevalent conditions (e.g. adult cardiovascular disease) but with patients willing to travel to seek the ‘best’ care,15 suggest that public reporting for CHS warrants independent investigation. The primary aims of the proposed project are: 1) to evaluate whether, as an unintended consequence of public reporting, there is a shift in patient case mix, suggesting that centers could be avoiding surgical intervention in patients at highest risk for poor outcome 2) to evaluate the association between implementation of public reporting for CHS and surgical outcomes, and 3) to better understand the type and format of data that CHD patients and families would find most meaningful to help them make informed decisions regarding care. Study aims 1 and 2 of the project propose obtaining data from the State Inpatient Database in order to study the association between public reporting, institutional case mix, and surgical outcomes at centers throughout the US performing CHS. Study Aim 3 proposes focus groups involving CHD patients and caregivers to gain an improved understanding of their preferences with regards to public reporting. Together with her mentorship team, Dr. Jayaram has worked to create a career development plan that will provide her with additional training, education, and experience in the areas of advanced statistical methodology, experience in working with administrative data, and formal training in qualitative research and patient engagement. Overall, the skills learned from this project and educational plan coupled with an outstanding mentorship team will allow Dr. Jayaram to achieve her ultimate goal of becoming an independent investigator and leader in the field of pediatric cardiovascular outcomes research.

项目总结/摘要 Natalie Jayaram，医学博士MSB是密苏里-堪萨斯大学的儿科助理教授 市和一名教员在儿科和心脏病科在儿童的慈善 密苏里州的堪萨斯城的医院。作为一名儿科心脏病专家和健康服务研究人员，她的长期研究 职业目标是改善先天性心脏病（CHD）患儿的护理， 质量评估的科学，通过审查基于政策的护理举措的有效性， 直接与患者合作，以促进护理的变化。目前项目的目标是研究公共 报告先天性心脏手术（CHS）。公共报告旨在为医疗保健消费者提供 具有给定提供者或机构的结果数据。公开报告的支持者主张透明 健康结果数据的披露，并认为公共报告导致改善的结果。 公开报告引用证据表明，公开报告可能不会大大改善结果，并可能导致 5 -14关于公共卫生影响的正式研究 从未报告社区卫生服务的结果。CHD护理的高度专业化性质， 与更普遍的疾病（例如成人心血管疾病）相比，局部或区域竞争相对较少 疾病），但患者愿意旅行以寻求“最好的”护理，15表明公众报告CHS 需要独立调查拟议项目的主要目的是：1）评估是否， 作为公开报道的一个意外后果，患者病例组合发生了变化，这表明中心 可以避免对预后不良风险最高的患者进行手术干预2）评估 CHS的公共报告的实施与手术结果之间的关联，以及3）更好地 了解CHD患者和家属认为最有意义的数据类型和格式 他们会在知情的情况下做出护理决定。该项目的研究目标1和2建议从以下方面获取数据： 国家住院病人数据库，以研究公共报告，机构病例组合， 和美国各地进行CHS的中心的手术结果。研究目标3提出焦点小组 让CHD患者和护理人员参与进来，以更好地了解他们在以下方面的偏好： 公开报道。Jayaram博士与她的导师团队一起， 该计划将为她提供高级统计领域的额外培训，教育和经验 方法，处理行政数据的经验，以及定性研究和 患者参与。总的来说，从这个项目和教育计划中学到的技能， 优秀的导师团队将使贾亚拉姆博士实现她成为一个独立的最终目标 儿科心血管结局研究领域的研究者和领导者。