Role of individual and hospital factors in quality of care for children in EDs

摘要 尽管大多数儿童在普通急诊科(ED)接受紧急护理，但国家研究 已经表明，儿科就绪性低，缺乏就绪性会对临床质量产生影响 和结果。在一家准备充分、儿科准备分数很高的医院的演示文稿是 与住院死亡率下降有关。儿科急救协调员(PECC)的在场是 与更高的就绪性相关联，但可用于直接评估 PECC状况和儿童护理质量。以前的工作主要集中在以下几个方面 专科儿科中心，占向儿科患者提供的护理的少数，并有非常 与一般急救人员相比，工作人员和资源不同。我们的长期目标是开发系统，以 改善对出现在普通急诊室的儿童的护理。该R01项目的目标是定义医院级别 与普通急诊室向儿童提供的护理质量有关的特点。我们将使用一块石板 最近开发的过程和结果质量衡量标准涵盖了地理位置不同的州，这些州具有高 提供高质量的儿科数据。我们的主要假设是，更密集的儿科工作人员配置(例如 更强大的PECC实施)与更高质量的护理和更好的临床结果相关 孩子们。具体目标是(1)确定与以下变化相关的PECC实施因素 儿童紧急护理的质量(2)确定PECC状态是否与更高的护理质量相关 在普通急诊室接受治疗的儿童和(3)确定是否按种族/族裔和 保险因PECC的地位而异。拟议的工作建立在我们与国家教育部门清单的试点工作的基础上 (NEDI-USA)数据库，以及我们团队在卫生服务研究方面的良好记录 行政数据库以及定性和实施方面的专门知识。在拟议的工作中，我们完成了以下两项工作 NICHD战略计划的主要目标：(1)“改善儿童和青少年健康”和(2) “无处不在的差异…改善体验特定文化、社会或访问的人群的方法 问题。“这些数据将提供对PECC、劳动力因素、 以及对儿童的护理质量。这一认识是开展循证医学的前提 采取干预措施，改善所有在普通急诊室接受紧急护理的儿童的结局。

Abstract Although most children receive emergency care in general emergency departments (EDs), national studies have shown that pediatric readiness is low and that the lack of readiness has consequences for clinical quality and outcomes. Presentation to a highly prepared hospital, one with a high pediatric readiness score, is associated with decreased in-hospital mortality. Presence of a pediatric emergency care coordinator (PECC) is associated with increased readiness, but limited data are available to directly assess the association between PECC status and quality of care for children. Previous work has focused primarily on quality variation among specialty pediatric centers which account for a minority of care provided to pediatric patients and have very different staffing and resources as compared to general EDs. Our long-term goal is to develop systems to improve care for children presenting to general EDs. The goal of this R01 project is to define the hospital-level characteristics associated with quality of care provided to children in general EDs. We will use a slate of recently developed process and outcome quality measures across geographically diverse states with high- quality pediatric data available. Our primary hypothesis is that more intensive pediatric-focused staffing (e.g. more robust PECC implementation) is associated with higher-quality care and better clinical outcomes for children. The specific aims are to (1) Identify PECC implementation factors that are associated with variation in quality of emergency care for children (2) Establish if PECC status is associated with higher quality of care for children treated in general EDs and (3) Determine if disparities in quality of care by race/ethnicity and insurance vary by PECC status. The proposed work builds on our pilot work with the National ED Inventory (NEDI-USA) database, as well as on our team’s strong track record in health services research with large administrative databases and qualitative and implementation expertise. In the proposed work, we fulfill two of the primary goals of the NICHD Strategic Plan: (1) “improving child and adolescent health” and (2) addressing “pervasive disparities…improving approaches in populations that experience specific cultural, social, or access issues.” These data will provide a critical understanding of the association between PECC, workforce factors, and quality of care for children. This understanding is the prerequisite for developing evidence-based interventions to improve outcomes for all children receiving emergency care in general EDs.