Detecting and Understanding Disparities in Pediatric Safety Events for Hospitalized Children

项目摘要/摘要：尽管几十年来一直致力于减少医疗差错，但儿童仍在遭受 医院环境中的实质性危害，以及医院中的儿科安全事件对儿童的影响不成比例 有色人种和生活在贫困中的人。虽然儿科已经对这些疾病进行了分类和解决， 安全事件，我们的理解和方法迫切需要消除种族化和社会化， 儿科安全事件的经济差异。长期目标是确保人人享有公平的保健服务 住院儿童总体目标是利用现有的儿科安全措施来检测和 了解选择住院儿科安全事件差异的驱动因素。中国的推进框架 患者安全方面的健康公平性，将通过患者和家属的参与来了解，包括 识别健康差异，了解驱动它们的潜在机制，然后设计 采取措施消除差距。在直接回应卫生保健研究和质量机构的 （AHRQ）最近发布了特别强调通知“关注卫生服务研究以促进健康 公平”NOT-HS-21-041，一项混合方法的研究，以推进国家实现公平的目标， 建议通过减少选择儿科患者安全事件的差异来提供医疗保健服务 通过这两个具体目标：1）。检测住院患者中儿科安全性事件的差异 按种族/族裔和/或社会经济地位分列的儿童。儿科安全性结局将包括AHRQ 儿科住院的儿科质量指标（PDI）和医疗器械不良事件（AMDE）发生率。 将评估儿童住院患者数据库和住院患者基本资料数据库的PDI差异， ADME。2）。了解消除种族歧视和仇外心理的机制， 儿科安全性事件的社会经济差异。将确定选定的儿科安全性事件， 将通过医院工作人员/临床医生和患者/家属的焦点小组进行深入的定性分析 查明造成差异的潜在机制和解决这些差异的干预措施。这一目标将是 由弗洛雷斯和Ngui的全面，病人和家庭为中心的框架，了解 儿科安全性事件的差异。本申请中提出的研究是创新的，因为 将使用已建立的儿科安全性指标结合 患者/家属参与，以全面了解选定措施的潜在驱动因素。的 拟议的研究是重要的，因为它有望提供一个更详细的了解选择 儿科安全性事件的差异，并确定解决这些差异的潜在干预措施。 这些结果预计将产生深远的积极影响，通过确定患者家庭为中心的候选人 针对未来R 01研究中儿科安全性的具体差异进行干预。该提案与 与AHRQ的目标和改善儿童医疗保健质量、安全和公平的优先人群相一致。

Project Summary/Abstract: Despite decades of focus on reducing medical errors, children continue to suffer substantial harms in hospital settings, and pediatric safety events in hospitals disproportionately affect children of color and those who live in poverty. While there has been work in pediatrics to categorize and address safety events, there is a critical need in our understanding and approaches to eliminate racialized and socio- economic disparities in pediatric safety events. The long-term goal is to ensure equitable care for all hospitalized children. The overall objectives are to leverage existing pediatric safety measures to detect and understand drivers of disparities in select inpatient pediatric safety events. The Chin framework for advancing health equity in patient safety, which is informed by patient and family engagement, will be used, and consists of identifying health disparities, understanding potential mechanisms that drive them, and then designing interventions to eliminate disparities. In direct response to Agency for Healthcare Research and Quality’s (AHRQ) recently released Special Emphasis Notice “Interest in Health Services Research to Advance Health Equity” NOT-HS-21-041, a mixed-methods study to advance the nation’s goal of achieving equity in the delivery of healthcare services by reducing disparities in select pediatric patient safety events is proposed through these two specific aims: 1). Detect disparities in pediatric safety events among hospitalized children by race/ethnicity and/or socioeconomic status. Pediatric safety outcomes will include the AHRQ pediatric quality indicators (PDIs) and adverse medical device event (AMDE) rates in pediatric hospitalizations. Both the Kids’ Inpatient Database and Inpatient Essentials database will be evaluated for disparities in PDIs or ADMEs. 2). Understand mechanisms and identify potential interventions for eliminating racialized and socio-economic disparities in pediatric safety events. Selected pediatric safety events will be identified and in-depth, qualitative analysis via focus groups of hospital staff/clinicians and patients/families will be conducted to identify potential mechanisms of disparities and interventions to address these disparities. This aim will be informed by Flores and Ngui’s comprehensive, patient-and-family centered framework for understanding disparities in pediatric safety events. The research proposed in this application is innovative because the disparities in pediatric safety events will be analyzed using established measures of pediatric safety combined with patient/family engagement to comprehensively understand potential drivers of selected measures. The proposed research is significant because it is expected to provide a more detailed understanding of select disparities in pediatric safety events and identification of potential interventions to address these disparities. These results are expected to have profound positive impact by identifying patient-family centered candidate interventions for addressing specific disparities in pediatric safety for future R01 study. This proposal aligns with AHRQ’s goals and priority population of improving health care quality, safety, and equity in children.