Measuring and Mapping National Pediatric Acute Care Outcomes

项目摘要/摘要 在每年2,500万次急诊科(ED)就诊中，儿童由于以下原因经历了各种各样的护理 两个急救队在准备和能力方面的主要差异。这些差异关系到一种可能性，即 患者将得到准确的诊断和及时、高质量的治疗。衡量整个行业的结果 整个国家的儿科急救系统被证明是困难的，因为粒状的、国家的、地理编码的 医疗保健数据一直不可用；调查人员专注于个别疾病；区域医疗保健 地图已经过时；对个人风险进行风险调整的挑战比比皆是；而且因为每一个 疾病需要一种不同的方法来衡量其结果。使努力进一步复杂化的是复杂的 医院之间的关系网络，其中多个设施分担结果责任。这些 成人和儿童患者之间的关系有很大的不同，没有工作上的理解 国家儿科网络的结构。这项提案将克服这些挑战，创建 儿科急诊图集--对3770万例急诊结果的综合考察 全国的儿童，占美国儿童人口的一半。地图集将绘制区域地图 医院系统使用复杂的网络分析算法，称为社区检测。地图 这一结果将确定儿科护理的领域，在这些领域中有共同的护理责任。它将被用来 要确定儿童三种严重疾病的区域性结果：阑尾炎(最常见的 儿童的手术情况)、神经损伤(最常见的严重伤害原因)和败血症(a 出了名的难以诊断的疾病，这是最昂贵的疾病之一)。这一知识随后将提供 在此基础上比较区域系统，以阐明与高绩效相关的因素。我们还将使用 全美使用患者和付款人的实际支出来了解成本的最高质量方法 儿科地区。这项提议反映了尤尼斯·肯尼迪·施莱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创伤、受伤、 以及“审查所有形式的危重疾病的流行病学和治疗”。 集中努力在全国范围内改善结果有可能改善人口健康，但 这取决于对结果的准确、多病种的理解。《地图集》将提供这样一个 理解，并将成为支持改善儿科急救工作的持久资源， 这将转化为国家儿童更好的生存和更高的生活质量。

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healthcare data have been unavailable; investigators have focused on individual diseases; regional healthcare maps are outdated; challenges abound with risk adjustment for individuals’ personal risk; and because each disease requires a different approach to measure its outcomes.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.