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，但儿童仍在遭受痛苦 医院环境中的重大危害以及医院中的儿科安全事件对儿童的影响不成比例 以及那些生活在贫困中的人。虽然已经有儿科的工作来分类和解决 在安全事件中，我们的理解和方法迫切需要消除种族主义和社会歧视 儿科安全事件中的经济差距。长期目标是确保所有人都得到公平的照顾 住院的儿童。总体目标是利用现有的儿科安全措施来检测和 了解住院儿科安全事件差异的驱动因素。前进的中国框架 患者安全方面的健康公平，通过患者和家属的参与来告知，将被使用，包括 识别健康差距，了解驱动这些差距的潜在机制，然后设计 旨在消除差距的干预措施。直接回应医疗研究和质量局的 (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“非-HS-21-041，一项混合方法研究，旨在推进国家实现公平的目标 建议通过减少选定儿科患者安全事件中的差异来提供医疗服务 通过这两个具体目标：1)。检测住院儿童安全事件的差异 按种族/族裔和/或社会经济地位分列的儿童。儿科安全结果将包括AHRQ 儿科住院中的儿科质量指标(Pdi)和不良医疗器械事件(Amde)率。 将对儿童住院患者数据库和住院患者基本数据库进行评估，以确定PDI或 ADME。2)。了解机制并确定潜在的干预措施，以消除种族主义和 儿科安全事件中的社会经济差异。选定的儿科安全事件将被确定和 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 确定潜在的差异机制和解决这些差异的干预措施。这一目标将是 由Flores和Ngui的全面、以患者和家庭为中心的理解框架提供信息 儿科安全事件的差异。本申请中提出的研究具有创新性，因为 将结合已建立的儿科安全措施来分析儿科安全事件中的差异 与患者/家属接触，全面了解选定措施的潜在驱动因素。这个 拟议的研究具有重要意义，因为它有望提供对SELECT的更详细的理解 儿科安全事件的差异以及确定解决这些差异的潜在干预措施。 预计这些结果将通过确定以患者家庭为中心的候选人产生深远的积极影响 为解决未来R01研究中儿科安全性的具体差异而采取的干预措施。这项建议符合 AHRQ的目标和重点人群是提高儿童保健质量、安全性和公平性。

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.