Role of individual and hospital factors in quality of care for children in EDs

个人和医院因素对急诊科儿童护理质量的作用

• 批准号: 10297524
• 负责人: Margaret Emily Samuels-Kalow
• 金额: $ 43.33万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10297524
• 关键词: Accident and Emergency department; Accounting; Address; Admission activity; Affect; Caring; Case Mixes; Characteristics; Child; Child Care; Child Health; Childhood; Clinical; Data; Databases; Emergency Care; Emergency Medicine; Emergency department visit; Ensure; Equipment; Equipment and supply inventories; Ethnic Origin; Evidence based intervention; Face; Geography; Goals; Grant; Health Care Costs; Health Services Research; Hospital Mortality; Hospitals; Image; Individual; Inpatients; Insurance; Insurance Coverage; Interview; Investigation; Knowledge; Link; Measures; Mediator of activation protein; Minority; Mission; National Institute of Child Health and Human Development; Nurses; Outcome; Patients; Pediatric Hospitals; Physicians; Policies; Population; Process; Public Health; Quality of Care; Race; Readiness; Research; Resources; Role; Strategic Planning; System; Time; Training; Travel; United States; United States Agency for Healthcare Research and Quality; Variant; Visit; Work; administrative database; adolescent health; care outcomes; disparity reduction; emergency settings; experience; health care disparity; health care service utilization; health disparity; implementation determinants; improved; improved outcome; interest; medical specialties; member; mortality; multilevel analysis; pediatric emergency; pediatric patients; social

Abstract Although most children receive emergency care in general emergency departments (EDs), national studies have shown that pediatric readiness is low and that the lack of readiness has consequences for clinical quality and outcomes. Presentation to a highly prepared hospital, one with a high pediatric readiness score, is associated with decreased in-hospital mortality. Presence of a pediatric emergency care coordinator (PECC) is associated with increased readiness, but limited data are available to directly assess the association between PECC status and quality of care for children. Previous work has focused primarily on quality variation among specialty pediatric centers which account for a minority of care provided to pediatric patients and have very different staffing and resources as compared to general EDs. Our long-term goal is to develop systems to improve care for children presenting to general EDs. The goal of this R01 project is to define the hospital-level characteristics associated with quality of care provided to children in general EDs. We will use a slate of recently developed process and outcome quality measures across geographically diverse states with high- quality pediatric data available. Our primary hypothesis is that more intensive pediatric-focused staffing (e.g. more robust PECC implementation) is associated with higher-quality care and better clinical outcomes for children. The specific aims are to (1) Identify PECC implementation factors that are associated with variation in quality of emergency care for children (2) Establish if PECC status is associated with higher quality of care for children treated in general EDs and (3) Determine if disparities in quality of care by race/ethnicity and insurance vary by PECC status. The proposed work builds on our pilot work with the National ED Inventory (NEDI-USA) database, as well as on our team’s strong track record in health services research with large administrative databases and qualitative and implementation expertise. In the proposed work, we fulfill two of the primary goals of the NICHD Strategic Plan: (1) “improving child and adolescent health” and (2) addressing “pervasive disparities…improving approaches in populations that experience specific cultural, social, or access issues.” These data will provide a critical understanding of the association between PECC, workforce factors, and quality of care for children. This understanding is the prerequisite for developing evidence-based interventions to improve outcomes for all children receiving emergency care in general EDs.

摘要 虽然大多数儿童在普通急诊科（ED）接受急诊护理，但全国研究表明， 已经表明，儿科准备是低，缺乏准备的后果，临床质量 和结果。介绍到一个高度准备的医院，一个具有高儿科准备得分，是 与降低住院死亡率相关。儿科急诊护理协调员（PECC）的存在是 与提高准备程度有关，但有限的数据可用于直接评估 PECC状况和儿童护理质量。以前的工作主要集中在质量变化之间 专业儿科中心占少数提供给儿科患者的护理， 与一般ED相比，不同的人员配置和资源。我们的长期目标是开发系统， 改善对普通急诊室就诊儿童的护理。本R 01项目的目标是定义医院级 与提供给儿童的护理质量相关的特征。我们将使用一个石板 最近在地理位置不同的州制定了过程和结果质量措施， 提供高质量的儿科数据。我们的主要假设是，更密集的以儿科为重点的人员配备（例如 更稳健的PECC实施）与更高质量的护理和更好的临床结局相关， 孩子具体目标是：（1）确定PECC实施因素，这些因素与 儿童急诊护理的质量（2）确定PECC状态是否与更高的护理质量相关， 接受普通急诊治疗的儿童和（3）确定种族/民族和性别的护理质量是否存在差异 保险因PECC地位而异。拟议的工作建立在我们与国家艾德库存的试点工作的基础上 （NEDI-USA）数据库，以及我们团队在卫生服务研究方面的良好记录， 行政数据库以及质量和执行方面的专门知识。在拟议的工作中，我们实现了两个 国家儿童和青少年发展中心战略计划的主要目标：（1）“改善儿童和青少年健康”;（2）解决 “普遍存在的差距.改善在经历特定文化、社会或机会的人口中的做法 问题”。这些数据将提供对PECC、劳动力因素 和儿童护理质量。这种理解是发展循证医学的前提 采取干预措施，改善所有在普通急诊室接受紧急护理的儿童的结局。