Process-Outcome Links in the National Stroke Project

描述（由申请人提供）：中风是常见的，昂贵的和毁灭性的。 中风是医疗保险受益人住院的第二大常见原因。 它也是造成大量死亡、发病和保健费用的原因。 迫切需要改善中风护理。 改善中风护理的一个主要限制因素是缺乏关于如何衡量中风护理质量的信息。 尽管一些组织已经确定过程测量作为潜在的质量指标，但关于所提出的测量是否实际影响临床实践中的卒中结局的数据很少。 我们将调查特定的过程措施是否与更好的结果在一个多样化的，以人口为基础的国家队列。 我们的目标是确定可用于评估急性缺血性卒中住院患者卒中护理质量的指标。 该应用程序基于国家卒中项目数据库进行分析。 国家中风项目是医疗保险和医疗补助研究计划中心的一部分，该研究计划关注医疗保险受益人中各州中风护理的质量指标。 我们的主要目的是确定特定的卒中护理过程是否与急性缺血性卒中住院患者的更好结局相关。 我们假设，在使用特定的护理过程的变化将与医院的结果（住院死亡率或出院到疗养院）的差异。 次要目的是探索在与更好的卒中结局相关的护理过程中，这些相关性是否独立于患者和结构特征。 我们的申请非常适合PA-01-040（AHRQ小型研究资助计划）。RO 3奖将允许对国家中风项目数据库进行新的分析。 本申请的目的和拟议的分析超出了拟议的分析，并提供资金，国家中风项目。 该研究项目的目的是通过产生新知识来补充和扩展原始的国家卒中项目目标，这些新知识将有助于加速验证质量措施的努力，改善护理的举措，并将有助于为大量和不断增长的美国脑血管疾病患者提供新的卫生服务研究工作。

DESCRIPTION (provided by applicant): Stroke is common, costly and devastating. Stroke is the second most common cause of hospitalization among Medicare beneficiaries. It is also responsible for substantial mortality, morbidity and health care costs. There is a desperate need to improve stroke care. A central constraint to improving stroke care has been a lack of information on how to measure the quality of stroke care. Although several organizations have identified process measures as potential quality indicators, few data are available regarding whether the proposed measures actually impact stroke outcomes in clinical practices. We will investigate whether specific process measures are associated with better outcomes in a diverse, population-based national cohort. Our goal is to define measures that can be used to assess the quality of stroke care among patients hospitalized with acute ischemic stroke. This application proposes analyses based on the National Stroke Project database. The National Stroke Project was part of a Center for Medicare and Medicaid Study program looking at quality indicators for stroke care, by state, among Medicare beneficiaries. Our primary aim is to determine whether specific processes of stroke care are associated with better outcomes among patients hospitalized with acute ischemic stroke. We hypothesize that variations in the use of specific processes of care will be associated with differences in hospital outcome (in-hospital mortality or discharge to nursing home). The Secondary aim is to explore if, among processes of care associated with better stroke outcomes, the associations are independent of patient and structural characteristics. Our application is ideally suited to PA-01-040 (AHRQ Small Research Grant Program). The RO3 Award will permit new analyses of the National Stroke Project database. The aims and proposed analyses of this application go beyond the analyses proposed, and funding available for, the National Stroke Project. The aims of this research project are designed to complement and extend, the original National Stroke Project goals by generating new knowledge that will be instrumental in accelerating efforts to validate quality measures, initiatives to improve care, and will help inform new health services research efforts for the large and growing population of Americans with cerebrovascular disease.