Measuring the Structure and Process of Pediatric Trauma Care

描述（由申请人提供）：创伤性脑损伤（TBI）是儿童和青少年创伤死亡的最常见原因，也是获得性残疾的最常见原因之一。康复被认为是严重创伤（尤其是严重创伤性脑损伤）后实现最佳康复的关键。然而，在确定康复护理的组织方式以及不同的护理过程如何与功能结果相关方面，特别是在儿童和青少年中，进展有限。一个关键的障碍是缺乏标准化的测量的组织和过程的护理和有限的可用性有效的测量标准，在住院康复受伤的病人。在本申请中，我们将确定和测量住院康复设施中TBI儿科患者的护理结构和过程，并检查康复设施和TBI儿科患者在这些方面的变化。我们将（1）开发一个系统，用于测量儿科TBI患者在住院康复期间接受的护理结构和过程。这将通过系统的文献综述和专家小组的德尔菲程序来完成。(2)评估和测试数据收集工具，可用于收集有关儿科住院康复护理的结构/组织和过程的信息。(3)使用这些工具来检查康复设施的结构/组织的变化，以及美国各地TBI儿科患者的康复护理过程。这项研究的长期目标是为受伤的儿童提供最佳护理，使他们在严重创伤后能够获得最好的结果。这个拟议的项目是减少护理差异的重要一步，并确定哪些护理会产生最佳结果。公共卫生相关性：这项研究的长期目标是为受伤的儿童提供最佳护理，使他们在严重创伤后能够获得最好的结果。这个拟议的项目是减少护理差异的重要一步，并确定哪些护理会产生最佳结果。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is the most common cause of death from trauma in children and adolescents and one of the most common causes of acquired disability. Rehabilitation has been viewed as critical to achieving optimal recovery after serious trauma, especially serious TBI. However, there has been limited progress on determining how the organization of rehabilitation care and how the different processes of care are related to functional outcome, especially in children and adolescents. A critical barrier has been the lack of standardized measurement of the organization and processes of care and limited availability of valid measurement criteria for care in the inpatient rehabilitation of injured patients. In this application, we will identify and measure the structure and processes of care in inpatient rehabilitation facilities for pediatric patients with TBI, and examine the variability in these dimensions across rehabilitation facilities and pediatric TBI patients. We will (1) develop a system for measuring the structure and processes of care received by pediatric TBI patients during inpatient rehabilitation. This will be done through a systematic review of the literature and a Delphi process with an expert panel. (2) Evaluate and test a data collection instrument that can be used to collect information on the structure/ organization and processes of care for pediatric inpatient rehabilitation. (3) Use these instruments to examine variations in the structure/ organization of rehabilitation facilities and in the processes of rehabilitation care for pediatric patients with TBI across the US. The long term goal of this study is to deliver optimal care to injured children so that they can attain the best possible outcomes after serious trauma. This proposed project is an essential step in reducing variations in care, and determining which care results in optimal outcomes. Public Health Relevance: The long term goal of this study is to deliver optimal care to injured children so that they can attain the best possible outcomes after serious trauma. This proposed project is an essential step in reducing variations in care, and determining which care results in optimal outcomes.