Measuring and Mapping National Pediatric Acute Care Outcomes

衡量和绘制全国儿科急性护理成果

• 批准号: 10714729
• 负责人: Kenneth Michelson
• 金额: $ 38.98万
• 依托单位: LURIE CHILDREN'S HOSPITAL OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10714729
• 关键词: Accident and Emergency department; Adult; Algorithmic Analysis; Appendicitis; Area; Atlases; Caring; Child; Child Care; Childhood; Communities; Comparative Effectiveness Research; Complex; Continuity of Patient Care; Cost Analysis; Critical Illness; Critically ill children; Data; Data Set; Databases; Detection; Diagnosis; Disease; District of Columbia; Emergency Care; Emergency Medicine; Emergency Situation; Emergency department visit; Emergency medical service; Ensure; Epidemiology; Expenditure; Family; Geographic Locations; Geography; Health Service Area; Health Services; Healthcare; Hospitals; Human Resources; Individual; Individual Adjustment; Injury; Interdisciplinary Study; Knowledge; Lead; Link; Maps; Measurement; Measures; Methodology; Methods; Modeling; National Institute of Child Health and Human Development; Nervous System Trauma; Operative Surgical Procedures; Outcome; Outcome Measure; Pathway Analysis; Patient-Focused Outcomes; Patients; Pattern; Patterns of Care; Performance; Physicians; Policy Maker; Population; Positioning Attribute; Privatization; Protocols documentation; Quality of life; Readiness; Reporting; Research; Research Personnel; Resources; Risk; Risk Adjustment; Rural; Sepsis; Severity of illness; Small-Area Analysis; Strategic Planning; Structure; System; Translating; Trauma; Variant; Work; accurate diagnosis; acute care; care outcomes; care seeking; care systems; cost; data quality; experience; health care service utilization; improved; improved outcome; injured; innovation; large scale data; longitudinal database; multilevel analysis; pediatric emergency; pediatric patients; population health; public health priorities

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.

项目摘要/摘要 在每年2500万急诊室（ED）访问中，儿童由于 EDS之间的准备和能力的主要差异。这些差异可能存在 患者将获得准确的诊断和及时的高质量治疗。测量跨越 事实证明，整个国家儿科急性护理系统已被证明很困难 医疗保健数据一直无法使用；调查人员专注于个体疾病；区域医疗保健 地图已过时；挑战以调整个人个人风险的风险；而且每个人 疾病需要一种不同的方法来衡量其结果。进一步的努力是复杂的 多个设施对结果负责的医院之间关系网络。这些 成人和儿童患者之间的关系大不相同，并且没有工作的理解 国家儿科网络的结构。该建议将克服这些挑战，以创建 小儿急性护理地图集，对3770万的急性护理结果进行了全面检查 全国儿童，代表了美国儿童人口的一半。地图集将绘制区域 使用复杂网络分析算法的医院系统称为社区检测。地图 该结果将定义小儿护理区域，其中有共同的护理责任。它将被使用 确定儿童三个严重疾病的区域结果：阑尾炎（最常见的 儿童的手术状况），神经瘤（严重受伤的最常见原因）和败血症（a 众所周知，难以诊断的状况是最昂贵的状况之一）。然后，这些知识将提供 比较区域系统以阐明与高性能相关的因素。我们还将使用 使用实际的患者和付款人支出，了解成本的最高质量方法 小儿区域。该提案反映了尤尼斯·肯尼迪·什里弗国家儿童研究所的优先事项 健康与人类发展：使用“大规模数据集来优化受伤，受伤， 和批判性儿童”和“检查所有形式的危重疾病的流行病学和治疗”。 集中精力以改善全国的成果有可能改善人口健康，但 取决于对结果的准确，多疾病的理解。地图集将提供这样的 理解并将成为一种持久的资源，以支持改善小儿急性护理的努力， 这将转化为国家儿童的更好生存和更高的生活质量。