Reducing Ethnic-racial Disparities in Cardiac Arrest Survival Outcomes (RED-CASO)

项目摘要/摘要 院外心脏骤停的公共卫生负担是巨大的，影响到约350,000人 在美国每年都是第三大致死原因。为了提高我们对uchA的理解， 心脏骤停登记以增强生存(CARE)是由埃默里大学和 疾病控制与预防。在过去20年里，通过70种同行评议的出版物，关爱 改变了我们对uchA患者的流行病学和预后的理解。然而，几乎没有 一些紧急医疗服务(EMS)机构如何实现更高的存活率 与其他机构相比，非甲氧西林肺炎患者的死亡率更高。而细胞色素A存活率的变化很大程度上被认为是由于 EMS机构在院前环境中采用的关键护理流程，这些流程是如何 在日常工作中使用，成功实施的基本因素，以及 EMS机构与社区、急救人员(例如，警察、消防)之间的有效互动，911 调度员和医院还没有得到系统的定义。此外，尽管布莱克和 西班牙裔患者的uchA存活率低于白人患者，但关于如何 减少uchA存活率方面的差距，以及在黑人占多数或 西班牙裔社区在院前应对和护理方面克服了额外的障碍。 因此，我们提出了RED-CASO(减少心脏骤停存活率中的种族差异 结果)研究，以解决这些关键的知识差距，并为质量改进奠定基础 努力减少联合国人权事务高级专员办事处存活率差异。首先，我们将确定表现最好和表现最差的EMS 联合国人权事务高级专员办事处的生存机构，重点是那些在黑人或西班牙裔占多数的社区工作的机构。 其次，我们将通过详细的计划，找出最好的EMS机构在uchA生存方面的最佳做法 在现场访问期间与主要利益相关者进行面谈。我们将有意抽样在以下地区工作的EMS机构 黑人或西班牙裔社区占多数，这些机构将至少占所访问网站的一半。和 第三，我们将验证这些与具有最高存活率的EMS机构相关的最佳实践 奥赫A。我们将使用顺序混合方法，重点是在顶层确定最佳实践- 执行EMS机构，在大多数居民是黑人或西班牙裔的社区工作。我们会 在我们调查团队工作的基础上，系统地了解与其他人的生存相关的因素 急诊设置(院内心脏骤停)，并利用我们团队在 心脏病学、急诊医学、流行病学和混合方法研究。这项研究的结果将是 用来构建一个可由EMS机构在以下两个领域内实施的uchA最佳实践指南 CARE并与美国心脏协会等国家合作伙伴合作，以改善 主要是非白人社区，并反过来减少在人权高专办成果方面的种族和族裔差异。

PROJECT SUMMARY / ABSTRACT The public health burden of out-of-hospital cardiac arrest (OHCA) is enormous, affecting ~350,000 individuals each year in the U.S. and is the third leading cause of death. To improve our understanding of OHCA, the Cardiac Arrest Registry to Enhance Survival (CARES) was launched by Emory University and the Centers for Disease Control and Prevention. Through >70 peer-reviewed publications over the past 2 decades, CARES has transformed our understanding of the epidemiology and outcomes of patients with OHCA. Yet, little is known as to how some emergency medical service (EMS) agencies achieve higher survival rates for their patients with OHCA than other agencies. While variation in OHCA survival is largely believed to be due to adoption of key care processes by EMS agencies in the prehospital setting, how these processes are employed in routine practice, the underlying factors contributing to their successful implementation, and effective interactions between EMS agencies with the community, first responders (e.g., police, fire), 911 dispatchers, and hospitals have not been systematically defined. Moreover, despite the fact that Black and Hispanic patients have lower survival rates for OHCA than White patients, there is scant research on how to reduce disparities in OHCA survival and how top-performing EMS agencies that work in majority Black or Hispanic communities overcome additional barriers to prehospital OHCA response and care. Accordingly, we propose the RED-CASO (Reducing Ethnic-racial Disparities in Cardiac Arrest Survival Outcomes) study to address these critical gaps in knowledge and to lay the foundation for quality improvement efforts to reduce disparities in OHCA survival. First, we will identify top-performing and bottom-performing EMS agencies in OHCA survival, with a focus on those that work in majority Black or Hispanic communities. Second, we will identify ‘best practices’ at top-performing EMS agencies in OHCA survival through detailed interviews with key stakeholders during site visits. We will intentionally sample EMS agencies which work in majority Black or Hispanic communities, and these agencies will comprise at least half of the sites visited. And third, we will validate these best practices associated with EMS agencies with the highest survival rates for OHCA. We will use a sequential mixed-methods approach with a focus on identifying best practices at top- performing EMS agencies which work in communities where most residents are Black or Hispanic. We will build on work by our investigative team to systematically understand factors associated with survival for other emergency settings (in-hospital cardiac arrest) and leverage our team’s multidisciplinary expertise in cardiology, emergency medicine, epidemiology, and mixed methods research. Findings from this study will be used to construct a ‘best practices guide’ for OHCA that can be implemented by EMS agencies both within CARES and with national partners such as the American Heart Association to improve OHCA survival in predominantly non-White communities and, in turn, reduce racial and ethnic disparities in OHCA outcomes.