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Using Outcomes to Guide Treatment of Surgical Emergencies

利用结果指导外科紧急情况的治疗

基本信息

批准号：
10402798
负责人：
Rachel Kelz
金额：
$ 50.29万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-15 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10402798
关键词：
Accident and Emergency department Acute Address Admission activity Adult Age Algorithms Alzheimer&apos s disease related dementia Caregivers Caring Characteristics Clinical Clinical effectiveness Code Comparative Effectiveness Research Complication Coronary heart disease Critical Care Custom Data Data Set Dementia Development Diabetes Mellitus Diagnosis Durable Medical Equipment Effectiveness Elderly Emergency Care Emergency Situation Emergency treatment Enrollment Ensure Ethics Evaluation Future HIV Health Policy Health Priorities Health system Heart failure Heterogeneity Hospitalization Hospitals Individual Inferior Institute of Medicine (U.S.)Intervention Knowledge Link Literature Malignant Neoplasms Measures Medicare Methods Modeling Nature Observational Study Operative Surgical Procedures Outcome Patient Care Patient-Focused Outcomes Patients Pattern Performance Policy Maker Population Prevalence Procedures Process Provider Race Randomized Controlled Trials Recurrence Reporting Research Design Risk Severity of illness Stroke Structure Subgroup Surgeon System Technology Trauma Trauma patient Treatment Cost Treatment outcome United States Ursidae Family Variant Vulnerable Populations Work adverse outcome age effect base beneficiary care burden care seeking care systems comorbidity comparative effectiveness comparative effectiveness analysis comparative effectiveness study cost design disorder risk emergency settings high risk hospital performance inpatient service insight instrument interest lifetime risk minimally invasive mortality novel older patient operation optimal treatments patient subsets preference provider factors readmission rates response service providers sociodemographic factors surgery outcome treatment effect treatment guidelines

项目摘要

Emergency general surgery (EGS) conditions are defined by a group of acute, non-trauma diagnoses that require presentation to an emergency department for operative or non-operative care. In the US, 3-4 million adults are hospitalized and treated for an EGS condition each year such that EGS conditions are responsible for 7% of all hospitalizations. EGS conditions result in an estimated 800,000 operations annually and cost ≈ $28 billion. The burden of EGS on inpatient care is greater than that of a new diagnosis of diabetes or cancer, coronary heart disease, heart failure, stroke, or HIV. Older adults, who are at increased risk of adverse outcomes, comprise more than half of the adult EGS population. Operative management of EGS conditions results in an overall complication rate of 50%, with a readmission rate of 4-18%, and a mortality rate that can approach 15%, with older patients demonstrating a significantly higher risk. Non-operative management is considered a reasonable alternative yet studies show mixed results. Randomized control trials are limited by the invasive nature of operative treatment, the heterogeneity of conditions, and the acute nature of EGS. Furthermore, most trials have compared different types of operative or non-operative interventions, with relatively few comparing operative treatment to non-operative treatment. A lack of evidence on the comparative effectiveness of operative and non- operative treatment has been shown to result in unnecessary variations in treatment and inferior operative outcomes. Furthermore, given the growing interest in the development of a regionalized system of care for EGS patients since the Institute of Medicine Committee report on the Future of Emergency Care in the United States Health System, knowledge on hospital performance in EGS is needed. This proposal aims to address these gaps in the literature with the following specific aims: (1) To identify hospital-level factors associated with rankings in EGS performance, (2) To evaluate the comparative effectiveness of operative and non-operative treatment in specific EGS conditions and (3) To evaluate heterogeneity in the effectiveness of operative treatment. Conditional effects of age, dementia and race will be examined amongst others. Using nationwide data from Medicare beneficiaries, the proposed study will be the first comparative effectiveness analysis of operative and non-operative treatment in EGS. The proposal employs: (1) template matching to define hospital quality in EGS (2) an instrumental variable approach with optimal near-far matching to overcome confounding by indication and, (3) interaction models to examine the conditional relationship between treatment and outcomes by patient factors. In so doing, the findings will provide insights into hospital factors necessary for optimal EGS outcomes and the comparative effectiveness of OP of EGS conditions. Policy makers will have evidence to inform systems- level restructuring to address the crisis in emergency care. Patients, caregivers and providers will benefit from the resultant high value care.

急诊普通外科（EGS）的条件是由一组急性，非创伤诊断，需要