The Congenital Heart Technical Skill Study: Improving Outcomes for Infants and Children with Congenital Heart Disease

先天性心脏病技术技能研究：改善患有先天性心脏病的婴儿和儿童的预后

• 批准号: 9528647
• 负责人: Brett Romeo Anderson
• 金额: $ 18.97万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-15 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9528647
• 关键词: Academic Medical Centers; Accounting; Anatomy; Attention; Award; Cardiac Surgery procedures; Caring; Characteristics; Child; Child Mortality; Clinical; Complex; Congenital Abnormality; Congenital Heart Defects; Data; Data Linkages; Data Set; Databases; Development Plans; Emergency department visit; Extracorporeal Membrane Oxygenation; Feedback; Future; Goals; Heart; Hour; Institution; Intensive Care Units; Intervention; Investigation; Knowledge; Learning; Length of Stay; Link; Literature; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Methods; Morbidity - disease rate; Neonatal; Nurses; Operating Rooms; Operative Surgical Procedures; Outcome; Outcomes Research; Patient-Focused Outcomes; Patients; Pediatric cardiology; Pediatrics; Performance; Perioperative; Postoperative Complications; Postoperative Period; Procedures; Provider; Quality of Care; Questionnaires; Registries; Repeat Surgery; Research; Research Personnel; Resources; Schedule; Societies; Source; Structure; Study Skills; Surgeon; System; Technical Expertise; Thoracic Surgeon; Time; United States; Variant; Work; bariatric surgery; cardiac intensive care unit; career development; comparative; congenital heart disorder; health economics; high risk population; hospital readmission; improved; improved outcome; infant outcome; innovation; instrument; mortality; multidisciplinary; operation; outcome prediction; peer; peer learning; professor; public health relevance; repaired; research data dissemination; response; skills

Brett R. Anderson, MD MBA MS/POR is an Assistant Professor of Pediatrics in the Division of Pediatric Cardiology at Columbia University Medical Center. Her long-term goal is to improve the quality and value of care provided to children with congenital heart disease. Congenital heart defects are the most common birth defects managed in the United States and have high associated morbidity, mortality, and resource utilization (1-3). There is marked variation in outcomes and resource utilization between centers and between surgeons (3-4). The sources of this variation are not known (4). In the research proposed for this award, Dr. Anderson will isolate surgeon technical skill as one possible driver of clinical outcomes for children with congenital heart disease and then examine the effects of institutional characteristics, after controlling for the effects of surgeons. The primary aims of the proposed research are 1) to determine the degree to which surgeon technical skill predicts outcomes for infants undergoing three highly complex congenital heart operations, and 2) to identify institutional characteristics associated with patient outcomes, after controlling for the technical skill of surgeons and the interactions between surgeon technical skill and institutional factors. This will be accomplished through innovative methodology that links peer ratings of direct, video observation of surgical skill to surgeon-specific patient outcomes from a national clinical registry and provider and center characteristics from a surgeon questionnaire. During the proposed 3-year Mentored Patient-Oriented Research Career Development Award (K23), Dr. Anderson’s knowledge and skills will be augmented through the implementation of a multidisciplinary career development plan and the guidance of an interdisciplinary team of mentors and advisors. Dr. Anderson’s career development plan will focus on the following four key modules: econometrics and outcomes research, quality assessment and quality improvement, utilization of large data and data linkage, and research dissemination and career development. The skills and knowledge obtained would 1) contribute immediately to improvements in the quality of congenital heart surgery, as surgeons learn how their performance compares to that of their peers and impacts the outcomes of their patients, 2) help to identify future targets for quality improvement, and 3) help Dr. Anderson to grow into an independent investigator, focused on the study of quality and value for children with congenital heart disease, capable both of leveraging the comparative advantages of multiple large datasets and of studying and implementing quality improvement initiatives.

布雷特河安德森，医学博士MBA MS/POR是儿科儿科系的儿科助理教授 哥伦比亚大学医学中心心脏病学。她的长期目标是提高 为患有先天性心脏病的儿童提供护理。先天性心脏缺陷是最常见的出生 在美国管理的缺陷，具有较高的相关发病率、死亡率和资源利用率 （1-3）。不同临床试验机构和不同外科医生之间的结果和资源利用存在显著差异 （3-4）。这种变化的来源尚不清楚（4）。在为这个奖项提出的研究中，安德森博士 将外科医生的技术技能作为先天性心脏病儿童临床结局的一个可能驱动因素 疾病，然后在控制了疾病的影响后，检查制度特征的影响 外科医生这项研究的主要目的是：1）确定外科医生在多大程度上 技术技能预测婴儿接受三个高度复杂的先天性心脏病手术的结果， 2)在控制技术技能后，识别与患者结局相关的机构特征 以及外科医生技术技能和制度因素之间的相互作用。这将是 通过创新方法实现，将手术的直接视频观察与同行评级联系起来， 来自国家临床登记处、提供者和中心外科医生特定患者结局的技能 外科医生问卷调查的特征。在拟议的3年指导患者导向 研究职业发展奖（K23），安德森博士的知识和技能将通过 实施多学科职业发展计划，指导多学科 导师和顾问团队。安德森博士的职业发展计划将侧重于以下四个关键 模块：计量经济学和成果研究，质量评估和质量改进， 大数据和数据连接、研究传播和职业发展。的技能和知识 1）立即有助于提高先天性心脏病手术的质量， 外科医生了解他们的表现如何与同行进行比较，并影响他们的结果。 2）帮助确定未来的质量改进目标，以及3）帮助安德森博士成长为一名 独立研究者，专注于先天性心脏病儿童的质量和价值研究， 既能够利用多个大型数据集的比较优势，又能够研究和 实施质量改进举措。