Measuring and Mapping National Pediatric Acute Care Outcomes

项目总结/摘要 在每年2500万次急诊（艾德）就诊中，由于以下原因，儿童经历了广泛多样的护理 ED之间的准备和能力存在重大差异。这些差异影响到一个 患者将得到准确的诊断和及时、高质量的治疗。衡量跨部门成果 事实证明，整个国家儿科急症护理系统很困难，因为粒度、国家、地理编码 医疗保健数据不可用;调查人员专注于个体疾病;区域医疗保健 地图是过时的;挑战比比皆是的风险调整个人的个人风险;因为每一个 疾病需要不同的方法来衡量其结果。更复杂的是， 医院之间的关系网络，其中多个设施共同负责结果。这些 成人和儿童患者之间的关系有很大的不同， 全国儿科网络的结构。本提案将克服这些挑战， 儿科急性护理地图集，对3770万例急性护理结果的全面检查 全国各地的儿童，这代表了美国儿童人口的一半。地图集将绘制区域 医院系统使用称为社区检测的复杂网络分析算法。地图 这一结果将确定分担护理责任的儿科护理区域。它将被用 确定儿童三种严重疾病的区域结果：阑尾炎（最常见的 儿童外科条件）、神经创伤（严重损伤的最常见原因）和败血症（ 众所周知，难以诊断的疾病是最昂贵的疾病之一）。这些知识将提供 比较区域系统的基础，以阐明与高性能相关的因素。我们还将使用 了解成本的最高质量方法，使用美国各地的实际患者和付款人支出 儿科区域。这项建议反映了尤尼斯·肯尼迪·施莱佛国家儿童研究所的优先事项。 健康和人类发展：使用“大规模数据集来优化创伤，受伤， 和危重儿童”和“检查各种形式的危重疾病的流行病学和治疗”。 在全国范围内集中努力改善结果有可能改善人口健康， 取决于对结果的准确的、多疾病的理解。地图集将提供这样一个 理解，并将成为一个持久的资源，以支持努力改善儿科急性护理， 这将转化为更好的生存和更高质量的生活，为国家的儿童。

PROJECT SUMMARY/ABSTRACT Across 25 million emergency department (ED) visits annually, children experience widely variable care due to major differences in readiness and capabilities between EDs. These differences bear on the likelihood that a patient will receive an accurate diagnosis and timely, high-quality treatment. Measuring outcomes across the entire national pediatric acute care system has proved difficult because granular, national, geocoded healthcare data have been unavailable; investigators have focused on individual diseases; regional healthcare maps are outdated; challenges abound with risk adjustment for individuals’ personal risk; and because each disease requires a different approach to measure its outcomes. Further complicating efforts is the complex network of relationships between hospitals in which multiple facilities share responsibility for outcomes. These relationships are substantially different between adult and child patients, and there is no working understanding of the structure of the national pediatric network. This proposal will overcome those challenges to create the Atlas of Pediatric Acute Care, a comprehensive examination of the acute care outcomes of 37.7 million children across the nation, which represents half of the US child population. The Atlas will map regional hospital systems using sophisticated network analysis algorithms known as community detection. The map that results will define regions of pediatric care in which there is a shared responsibility for care. It will be used to determine regional outcomes across three serious conditions in children: appendicitis (the most common surgical condition in children), neurotrauma (the most common cause of serious injury), and sepsis (a notoriously difficult-to-diagnose condition that is one of the costliest). This knowledge will then provide the basis to compare regional systems to elucidate the factors associated with high performance. We will also use the highest-quality methods to understand costs, using actual patient and payer expenditures, across US pediatric regions. This proposal reflects the priorities of the Eunice Kennedy Shriver National Institute of Child Health and Human Development: to use “large-scale datasets to optimize outcomes for traumatized, injured, and critically ill children” and to “examine the epidemiology and treatment of all forms of critical illness.” Focusing efforts to improve outcomes nationally has the potential to improve the population health, but depends on an accurate, multi-disease understanding of outcomes. The Atlas will provide such an understanding and will emerge as an enduring resource to support efforts to improve pediatric acute care, which will translate to better survival and higher quality of life for the nation’s children.