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

减少心脏骤停生存结果的种族差异 (RED-CASO)

• 批准号: 10598514
• 负责人: Paul Sheung-Yan Chan
• 金额: $ 67.78万
• 依托单位: SAINT LUKE'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10598514
• 关键词: 911 call; Accident and Emergency department; Address; Administrator; Adopted; Adoption; Affect; American Heart Association; Baseline Surveys; Black Populations; Black race; Cardiology; Cardiopulmonary Resuscitation; Caring; Cause of Death; Censuses; Centers for Disease Control and Prevention (U.S.); Circulation; Communities; Community Services; Data; Effectiveness; Emergency Medicine; Emergency medical service; Ensure; Epidemiology; Ethnic Origin; Face; Fire - disasters; Focus Groups; Foundations; Future; Goals; Heart Arrest; Hispanic; Hispanic Populations; Hospitals; Immigration; Individual; Interview; Knowledge; Language; Life; Low income; Medical Staff; Methodology; Methods; Mission; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Native Americans; Neighborhoods; Outcome; Outcome Study; Paramedical Personnel; Patient-Focused Outcomes; Patients; Peer Review; Persons; Police; Policies; Practice Guidelines; Pre-hospital setting; Pre-hospitalization care; Process; Public Health; Publications; Registries; Research; Research Methodology; Research Personnel; Resources; Resuscitation; Risk Adjustment; Sampling; Site; Site Visit; Surveys; Survival Rate; System; Time; Universities; Variant; Work; care systems; community engagement; cost; design; disparity reduction; emergency settings; ethnic disparity; first responder; health equity; health equity promotion; hispanic community; improved; improved outcome; innovation; insight; mortality; multidisciplinary; novel; out-of-hospital cardiac arrest; premature; racial disparity; response; routine practice; survival outcome

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.

项目总结/摘要 院外心脏骤停（OHCA）的公共卫生负担是巨大的，影响到约35万人 每年在美国，是第三大死亡原因。为了加深我们对OHCA的了解， 心脏骤停登记以提高生存率（CARES）是由埃默里大学和心脏病研究中心发起的。 疾病控制和预防。在过去的20年里，通过70多篇同行评议的出版物， 改变了我们对OHCA患者的流行病学和结局的理解。然而， 众所周知，一些紧急医疗服务（EMS）机构如何实现更高的生存率， OHCA的病人比其他机构。虽然OHCA生存率的变化主要是由于 EMS机构在院前环境中采用关键护理流程，这些流程如何 在日常实践中使用的，有助于其成功实施的基本因素，以及 EMS机构与社区，第一响应者（例如，警察，消防），911 调度员和医院尚未系统地定义。此外，尽管布莱克和 西班牙裔患者的OHCA生存率低于白色患者，关于如何 减少OHCA生存的差异，以及如何在大多数黑人或 西班牙裔社区克服了院前OHCA反应和护理的额外障碍。 因此，我们提出了RED-CASO（减少心脏骤停生存率的种族差异）， 成果）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OHCA生存率的差异。首先，我们将确定表现最好和表现最差的环境管理体系 OHCA生存的机构，重点是那些在大多数黑人或西班牙裔社区工作的机构。 其次，我们将通过详细的分析， 在实地考察期间与主要利益攸关方进行访谈。我们将有意抽样EMS机构的工作， 大多数黑人或西班牙裔社区，这些机构将包括至少一半的访问地点。和 第三，我们将验证与EMS机构相关的最佳实践，这些机构的生存率最高， OHCA。我们将使用顺序混合方法，重点是确定最佳实践- 在大多数居民是黑人或西班牙裔的社区工作的EMS机构。我们将 在我们的调查团队的工作基础上，系统地了解与其他人的生存相关的因素， 紧急情况（院内心脏骤停），并利用我们团队的多学科专业知识， 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 用于为OHCA构建一个“最佳实践指南”，可由EMS机构实施， CARES和国家合作伙伴，如美国心脏协会，以提高OHCA的生存率， 主要是非白人社区，并反过来减少OHCA结果中的种族和民族差异。