权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Using Outcomes to Guide Treatment of Surgical Emergencies

利用结果指导外科紧急情况的治疗

基本信息

批准号：
10619027
负责人：
Rachel Kelz
金额：
$ 53.31万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-15 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10619027
关键词：
Accident and Emergency department Acute Address Admission activity Adult Age Algorithms Alzheimer&apos s disease related dementia Caregivers Caring Characteristics Clinical Clinical effectiveness Code Comparative Effectiveness Research Complication Coronary heart disease Critical Care Data Data Set Dementia Development Diabetes Mellitus Diagnosis Durable Medical Equipment Effectiveness Elderly Emergency Care Emergency Situation Emergency treatment Enrollment Ethics Evaluation Future HIV Health Policy Health Priorities Health system Heart failure Heterogeneity Hospitalization Hospitals Individual Inferior Institute of Medicine (U.S.)Intervention Knowledge Link Literature Malignant Neoplasms Measures Medicare Methods Modeling Nature Newly Diagnosed Observational Study Operative Surgical Procedures Outcome Patient Care Patient-Focused Outcomes Patients Pattern Performance Policy Maker Population Prevalence Procedures Process Provider Race Randomized, Controlled Trials Recurrence Recurrent disease Reporting Research Design Risk Severity of illness Stroke Structure Subgroup Surgeon System Technology Trauma Trauma patient Treatment Cost Treatment outcome United States Variant Vulnerable Populations Work adverse outcome age effect beneficiary care providers care seeking care systems comorbidity comparative effectiveness comparative effectiveness analysis comparative effectiveness study cost design emergency settings high risk hospital performance improved inpatient service insight instrument interest lifetime risk minimally invasive mortality novel older patient operation optimal treatments patient subsets preference provider factors readmission rates response service providers sociodemographic factors surgery outcome treatment and outcome treatment effect treatment guidelines usability

项目摘要

Emergency general surgery (EGS) conditions are defined by a group of acute, non-trauma diagnoses that require presentation to an emergency department for operative or non-operative care. In the US, 3-4 million adults are hospitalized and treated for an EGS condition each year such that EGS conditions are responsible for 7% of all hospitalizations. EGS conditions result in an estimated 800,000 operations annually and cost ≈ $28 billion. The burden of EGS on inpatient care is greater than that of a new diagnosis of diabetes or cancer, coronary heart disease, heart failure, stroke, or HIV. Older adults, who are at increased risk of adverse outcomes, comprise more than half of the adult EGS population. Operative management of EGS conditions results in an overall complication rate of 50%, with a readmission rate of 4-18%, and a mortality rate that can approach 15%, with older patients demonstrating a significantly higher risk. Non-operative management is considered a reasonable alternative yet studies show mixed results. Randomized control trials are limited by the invasive nature of operative treatment, the heterogeneity of conditions, and the acute nature of EGS. Furthermore, most trials have compared different types of operative or non-operative interventions, with relatively few comparing operative treatment to non-operative treatment. A lack of evidence on the comparative effectiveness of operative and non- operative treatment has been shown to result in unnecessary variations in treatment and inferior operative outcomes. Furthermore, given the growing interest in the development of a regionalized system of care for EGS patients since the Institute of Medicine Committee report on the Future of Emergency Care in the United States Health System, knowledge on hospital performance in EGS is needed. This proposal aims to address these gaps in the literature with the following specific aims: (1) To identify hospital-level factors associated with rankings in EGS performance, (2) To evaluate the comparative effectiveness of operative and non-operative treatment in specific EGS conditions and (3) To evaluate heterogeneity in the effectiveness of operative treatment. Conditional effects of age, dementia and race will be examined amongst others. Using nationwide data from Medicare beneficiaries, the proposed study will be the first comparative effectiveness analysis of operative and non-operative treatment in EGS. The proposal employs: (1) template matching to define hospital quality in EGS (2) an instrumental variable approach with optimal near-far matching to overcome confounding by indication and, (3) interaction models to examine the conditional relationship between treatment and outcomes by patient factors. In so doing, the findings will provide insights into hospital factors necessary for optimal EGS outcomes and the comparative effectiveness of OP of EGS conditions. Policy makers will have evidence to inform systems- level restructuring to address the crisis in emergency care. Patients, caregivers and providers will benefit from the resultant high value care.

急诊普通外科 (EGS) 病症是由一组急性、非创伤性诊断定义的，这些诊断需要到急诊室进行手术或非手术治疗。在美国，有 3-400 万成年人每年因 EGS 病症住院并接受治疗，其中 EGS 病症占所有患者的 7% 住院治疗。 EGS 条件导致每年约 800,000 次操作，成本约 280 亿美元。这 EGS 对住院患者护理的负担比新诊断出的糖尿病或癌症、冠心病的负担还要大疾病、心力衰竭、中风或艾滋病毒。老年人出现不良后果的风险增加，包括超过一半的成人 EGS 人口。 EGS 条件的运营管理可带来整体效果并发症发生率为 50%，再入院率为 4-18%，死亡率接近 15%，老年患者表现出明显更高的风险。非手术治疗被认为是合理的另类研究显示结果好坏参半。随机对照试验受到侵入性性质的限制手术治疗、病情的异质性以及 EGS 的急性性质。此外，大多数试验都比较了不同类型的手术或非手术干预措施，比较手术干预措施的相对较少治疗以非手术治疗为主。缺乏关于手术治疗和非手术治疗的比较有效性的证据手术治疗已被证明会导致不必要的治疗变化和较差的手术治疗结果。此外，鉴于人们对开发 EGS 区域化护理系统的兴趣日益浓厚自医学研究所委员会报告美国急诊护理的未来以来患者数量卫生系统需要了解医院在 EGS 方面的表现。该提案旨在解决这些问题文献中的空白具有以下具体目的：（1）确定与排名相关的医院层面因素 (2) 评估手术治疗和非手术治疗的比较效果 (3) 评估手术治疗效果的异质性。除其他外，还将检查年龄、痴呆症和种族的条件影响。使用全国范围内的数据对于医疗保险受益人来说，拟议的研究将是第一个对手术和治疗效果进行比较分析的研究 EGS 的非手术治疗。该提案采用：（1）模板匹配来定义EGS中的医院质量 (2) 具有最佳远近匹配的工具变量方法，以克服指示的混杂因素， (3) 交互模型，用于检查患者治疗与结果之间的条件关系因素。这样一来，研究结果将深入了解实现最佳 EGS 结果所需的医院因素以及 EGS 条件下 OP 的比较有效性。政策制定者将有证据告知系统—— 级别重组以解决紧急护理危机。患者、护理人员和提供者将受益于由此产生的高价值护理。