Reducing Rural Disparities in Cardiac Arrest Outcomes by Standardization of Care

通过护理标准化减少农村地区心脏骤停结果的差异

• 批准号: 10558707
• 负责人: Teresa May
• 金额: $ 45.58万
• 依托单位: MAINEHEALTH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-10 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10558707
• 关键词: Accident and Emergency department; Admission activity; Affect; Attention; Benchmarking; Cardiopulmonary Bypass; Caring; Cause of Death; Centers of Research Excellence; Clinical; Clinical Trials; Collaborations; Communication; Complex; Country; Critical Care; Data; Data Analyses; Data Sources; Development; Development Plans; Disparity; Emergency medical service; Emergency response; Epidemiology; Face; Future; Goals; Guidelines; Healthcare Systems; Heart Arrest; Hospitalization; Hospitals; Injury; Intensive Care Units; Intervention; Lead; Location; Maine; Managed Care; Measures; Medical emergency; Mentorship; Methods; Myocardial Infarction; North America; Outcome; Pathway interactions; Patient Care; Patient Triage; Patient-Focused Outcomes; Patients; Physiologic pulse; Policies; Positioning Attribute; Protocols documentation; Provider; Qualitative Research; Recommendation; Reporting; Research; Research Personnel; Resources; Resuscitation; Risk Adjustment; Rural; Rural Health; Standardization; Subgroup; Surveys; System; Testing; Time; Training; Travel; Treatment Protocols; Weather; Work; acute care; biomedical referral center; cardiovascular disorder risk; care systems; community center; design; disparity reduction; experience; geographic disparity; health difference; implementation science; improved; improved outcome; learning community; mortality; organ injury; out-of-hospital cardiac arrest; outcome disparities; rural area; rural disparities; rural health disparities; rural patients; rurality; socioeconomic disparity; standardized care; tertiary care; treatment strategy; trend; urban area

Abstract Patients in rural areas who suffer a cardiac arrest have had worse outcomes compared to those in urban areas. This is due in part to socioeconomic disparities influencing the underlying risk of cardiovascular disease, availability of emergency medical services, and transport time. In addition, little attention is paid to the workflow of patient care after a pulse has been restored. Improving standardization of care between the time patients arrive in the emergency department through the remainder of their care is an important opportunity to limit the disparities seen in rural areas. The hypothesis that underlies this project is that trending risk-adjusted outcomes over time at a state-level, combined with standardization of post-resuscitation care, will improve outcomes for rural patients and thus decrease rural disparities across the state. This project brings together local expertise in epidemiology, policy reform and qualitative studies to 1) determine the influence of rurality on cardiac arrest mortality using risk-adjusted analysis of all patients treated after cardiac arrest across Maine; and 2) develop a multi-center learning community for hyper-acute post-cardiac arrest management to measure treatment metrics and implement standardization protocols to reduce geographical disparities. In the first aim, we will utilize nationally available emergency medical department data to perform a risk-adjusted analysis of statewide available data to determine how rurality affects overall outcomes across the state and identify the variability of outcome among rural areas. In the second aim, we will develop a learning community in seven centers across rural, regional and tertiary centers to implement established protocols for the hyper-acute management of cardiac arrest care. We will use patient-level data to determine baseline and subsequent benchmark data and measure how this changes over time, while taking into consideration regional resources and differences in health care systems. The completion of this project is a critical step in achieving the long- term goal of creating a method to improve systems of care for the state of Maine that can be replicated in other rural states, which will reduce rural health disparities related to out-of-hospital cardiac arrest. This project is led by Dr. Teresa May, a junior clinical researcher with a background in critical care and neurocritical care who recently completed KL2 training where she studied in-hospital aspects of post-cardiac arrest care. With strong mentorship in the areas of rural health research, complex survey designs, data analysis (Y. Jonk) and increasing access to clinical trials in rural areas and implementation science research (R. Kramer), she is well positioned to succeed. This project represents a unique opportunity for Dr. May to develop experience in data-driven development of multi-center learning communities to standardize and improve efficiency of post-resuscitation care. Project results will be applicable to other rural areas around the country, increasing the impact of this research.

摘要 与城市相比，农村地区心脏骤停患者的预后更差。 区域。这在一定程度上是由于社会经济差异影响了心血管疾病的潜在风险， 紧急医疗服务的可获得性和运输时间。此外，对工作流的关注很少 脉搏恢复后的病人护理。提高患者间隔时间护理的标准化程度 通过其剩余的护理到达急诊科是限制 在农村地区看到的差距。这个项目背后的假设是，趋势风险调整后 随着时间的推移，州一级的结果，再加上复苏后护理的标准化，将会有所改善 这将有助于改善农村患者的生活质量，从而缩小全州的农村差距。这个项目汇集了 当地在流行病学、政策改革和定性研究方面的专门知识，以1)确定农村对 对缅因州所有心脏骤停后接受治疗的患者进行风险调整分析，得出心脏骤停死亡率； 以及2)为超急性心脏骤停后管理开发多中心学习社区，以测量 治疗指标和实施标准化方案，以减少地域差异。第一个目标是， 我们将利用全国可用的急救医疗部门数据进行风险调整分析 全州范围内可用的数据，以确定农村如何影响全州的总体结果，并确定 农村地区之间结果的变异性。在第二个目标中，我们将在七年内建立一个学习社区 跨越农村、区域和三级中心的中心，以实施针对特急症患者的既定方案 心脏骤停护理的管理。我们将使用患者级别的数据来确定基线和后续 在考虑地区资源的同时，对数据进行基准测试，并衡量这种情况随时间的变化情况 以及医疗保健系统的差异。该项目的建成是实现长治久安的关键一步。 创建一种方法来改善缅因州的护理系统的长期目标，该方法可以在其他地区复制 农村州，这将减少与院外心脏骤停有关的农村健康差距。 该项目由特蕾莎·梅博士领导，她是一名初级临床研究员，具有重症监护和 神经危重护理，最近完成了KL2培训，在那里她学习了心脏术后的医院方面 逮捕关怀中心。在农村卫生研究、复杂的调查设计、数据等领域拥有强大的导师 分析(Y.Jonk)和增加获得农村地区临床试验和实施科学研究的机会 (克莱默)，她已经做好了成功的准备。这个项目为梅博士提供了一个独特的机会 在数据驱动的多中心学习社区开发方面积累经验，以标准化和 提高复苏后护理的效率。项目成果将适用于周边其他农村地区 增加了这项研究的影响。