Advancing Health Policy and Systems Approaches to Improved Delivery of Surgical Limb Salvage Procedures for Severe Chronic Wounds

项目概要/摘要 在美国，240万至450万人患有慢性下肢创伤， 卫生系统每年增加317亿美元。多学科的方法是必要的截肢减少 在严重创伤中，非创伤性截肢导致50- 75%的5年死亡率。已经 表明，建立保肢中心可以降低截肢率，提高供应商， 提供者教育，导致早期转诊，改善预防措施，提高全球运作 病人。 目前，对美国医院采用保肢手术的情况知之甚少， 包括最常用的手术方式，它们在区域和时间上的分布，以及 相对于社区需求的业务规模。更不知道这种护理是如何组织的 在当地医院市场，以及这些市场的结构如何影响哪些患者接受肢体 抢救还是截肢这种基本知识的缺乏是提高生物多样性的障碍。 组织和分配资源密集型伤口护理团队，以治疗美国的慢性伤口。 结果，保肢的特点是零散的交付，不公平的规定，很少的质量标准， 普遍存在的按服务收费的支付机制，众所周知，这种机制缺乏对质量或效率的激励。 在COVID-19大流行期间，这些问题可能会变得越来越重要，因为护理延误可能会导致 更多患者在寻求治疗之前出现严重慢性伤口。 本项目将通过开展第一次大规模的保肢评估来填补这些空白 美国下肢创伤的传播、供应和市场效应。在目标1下，将使用 2005-2017年医疗保健成本和利用项目（HCUP）-国家住院病人数据库（SID）链接到 美国医院年度（AHA）调查，以检查医院市场结构，医院因素， 患者因素在采用和推广保肢手术及其对护理差异的影响。 在目标2下，我们会委聘专家顾问团，协助把目标1的研究结果转化为一套 可操作的卫生系统和政策战略，向从业人员传播研究结果，并开展研究 推进急需的医疗支付和交付改革的议程， 慢性伤口护理这项研究将推动AHRQ的优先事项，以传播基于证据的做法，并发展 基金会处理其他优先事项，包括系统和供应商的比较性能，以及 制定绩效改进激励措施。这些调查结果对AHRQ特别重要 重点人群，包括低收入、少数民族、农村和慢性病患者。

PROJECT SUMMARY/ABSTRACT In the United States, 2.4-4.5 million people suffer from chronic lower extremity wounds, costing the health system up to $31.7 billion annually. A multidisciplinary approach is necessary for amputation reduction in severe wounds, as nontraumatic amputation leads to a 5-year mortality rate of 50-75%. It has been demonstrated that the establishment of limb salvage centers reduces amputation rates, improves provider to provider education resulting in earlier referral, improves prevention measures and increases global functioning of patients. Currently, little is known about the state of limb salvage adoption by hospitals in the United States, including which surgical modalities are most commonly used, their spread across regions and over time, and the scale of operations relative to community-based need. Even less is known about how this care is organized within local hospital markets and how the structure of these markets affects which patients receive limb salvage versus amputations. This lack of fundamental knowledge stands as a barrier to improvements in the organization and distribution of resource-intensive wound care teams to treat chronic wounds in the U.S. As a result, limb salvage is characterized by fragmented delivery, inequitable provision, few quality standards, and pervasive fee-for-service payment mechanisms with their well-known lack of incentives for quality or efficiency. These issues are likely to grow in importance during the COVID-19 pandemic, as delays in care will likely lead to more patients developing severe chronic wounds before seeking treatment. This project will address these gaps by conducting the first large-scale assessment of limb salvage spread, provision, and market effects for lower extremity wounds in the United States. Under Aim 1, will use the 2005-2017 Healthcare Cost and Utilization Project (HCUP) – State Inpatient Database (SID) linked to the American Hospital Annual (AHA) Survey to examine the role of hospital market structure, hospital factors, and patient factors in the adoption and spread of limb salvage procedures and its effects on disparities in care. Under Aim 2, we will engage an Expert Advisory Panel to help translate the findings from Aim 1 into a set of actionable health system and policy strategies, disseminate findings to practitioners, and develop a research agenda for advancing much-needed healthcare payment and delivery reforms in the provision of severe chronic wound care. This study will advance AHRQ’s priority to spread evidence-based practices and develop the foundation to address other priorities including comparative performance of systems and providers, and development of performance-improvement incentives. These findings will be especially important to AHRQ priority populations, including low-income, minority, rural, and people with chronic illnesses.