Improving the Quality of Pediatric Emergency Care Using an Electronic Medical Rec

使用电子医疗记录提高儿科急诊护理的质量

• 批准号: 8237108
• 负责人: Elizabeth Rachel Alpern
• 金额: $ 49.14万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2016-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8237108
• 关键词: Improving; Quality; Pediatric; Emergency; Care

DESCRIPTION (provided by applicant): Approximately 20% of all children in the U.S. will have at least one Emergency Department (ED) visit each year. Patients and caregivers expect clinicians to deliver high quality emergency care, yet many children do not receive appropriate care under the current system. The Institute of Medicine report, "Emergency Care for Children: Growing Pains," notes that the delivery of care should be built on a strong foundation in which emergency care is based on scientific evidence, data are collected so clinicians can learn from past experience, and system performance is monitored to ensure quality. While EDs routinely collect substantial patient data with the potential to provide information on the quality of care provided, the capacity to capture, analyze and report these data back to front-line clinicians capable of acting to improve health care delivery has been limited. Leveraging advances in health information technology to access patient-centric clinical data, researchers can measure and identify variation in performance and outcomes, enhancing the ability to design and implement interventions to improve outcomes and quality of care across multiple settings. The increasing use of the electronic health record (EHR) in EDs provides a unique opportunity. Utilizing the infrastructure of the Pediatric Emergency Care Applied Research Network (PECARN), this proposal will innovatively capture EHR data to implement and report performance measures with the ultimate goal of improving the quality of emergency care for children. This proposal will develop an emergency care visit registry for pediatric patients from EHR clinical data which will serve as the foundation for the current and future studies, precluding the need for resource-intensive chart review. Emergency care performance measures will be derived from registry data and we will measure variability among sites and individual clinicians. Data from the registry and qualitative methods will be used to set benchmarks of care. We will design site- and clinician-level Quality Performance Measure Report Cards that will be generated from the registry and distributed monthly. The registry will be utilized to evaluate the performance measures in a prospective manner for improvement in the measures themselves as well as decreased variation in performance across practitioners. Significant improvements by individual practitioners should also manifest as improvement at the site level. We will test the hypothesis that providing regular performance measure feedback will improve performance and decrease variation among ED clinicians using a staggered time-series study. The proposed project, thus, has enormous potential to improve our ability to evaluate systems of health care delivery, as well as to lead to improvements in the quality of care provided to acutely ill or injured children. Although this proposal centers on health care delivered to children in EDs, the principles delineated apply to all components of the healthcare system that collect electronic patient data. Accordingly, this proposal should be viewed as having wide applicability for comparative effectiveness research and quality improvement across all healthcare domains. PUBLIC HEALTH RELEVANCE: Every day, 80,000 children seek care in emergency departments (EDs), these patients and caregivers expect emergency clinicians to deliver high quality care, yet many children do not receive appropriate treatment under the current system. We intend to establish a data registry from electronic health records to collect and report quality measures of emergency care provided to children. We will establish measurable benchmarks and implement a clinician feedback intervention to improve performance; this proposed project will allow systematic and widespread collection and reporting of performance and outcomes and is critical to allow clinicians and emergency care stakeholders to improve care beyond the local level.

描述（由申请人提供）：在美国，大约20%的儿童每年至少有一次急诊（艾德）就诊。患者和护理人员期望临床医生提供高质量的急诊护理，但许多儿童在当前系统下得不到适当的护理。医学研究所的报告《儿童紧急护理：成长的痛苦》指出，护理的提供应该建立在一个坚实的基础上，其中紧急护理是基于科学证据的，收集数据以便临床医生可以从过去的经验中学习，并监测系统性能以确保质量。虽然ED定期收集大量患者数据，有可能提供有关所提供护理质量的信息，但捕获，分析和报告这些数据的能力有限，一线临床医生能够采取行动改善医疗保健服务。利用健康信息技术的进步来访问以患者为中心的临床数据，研究人员可以测量和识别性能和结果的变化，提高设计和实施干预措施的能力，以改善多种环境中的结果和护理质量。电子健康记录（EHR）在急诊室的使用越来越多，这提供了一个独特的机会。利用儿科急诊应用研究网络（PECARN）的基础设施，该提案将创新性地捕获EHR数据，以实施和报告绩效指标，最终目标是提高儿童急诊护理的质量。该提案将根据EHR临床数据为儿科患者开发一个紧急护理访视注册表，该注册表将作为当前和未来研究的基础，从而无需进行资源密集型图表审查。急诊护理性能指标将来自登记数据，我们将测量研究中心和个体临床医生之间的差异。登记处的数据和定性方法将用于制定护理基准。我们将设计研究中心和临床医生级质量绩效指标报告卡，该报告卡将从登记研究中生成并每月分发。该登记研究将用于以前瞻性方式评价性能指标，以改进指标本身并减少从业人员之间的性能差异。个别从业人员的重大改进也应体现在现场一级的改进上。我们将测试的假设，提供定期的性能指标反馈将提高性能和减少艾德临床医生之间的变化，使用交错的时间序列研究。因此，拟议的项目具有巨大的潜力，可以提高我们评估保健提供系统的能力，并导致改善向重病或受伤儿童提供的护理质量。虽然该提案的重点是向急诊室儿童提供医疗保健，但所描述的原则适用于收集电子患者数据的医疗保健系统的所有组成部分。因此，这一建议应被视为具有广泛的适用性，比较有效性研究和质量改进在所有医疗保健领域。 公共卫生相关性：每天有80，000名儿童在急诊科寻求护理，这些患者和护理人员期望急诊临床医生提供高质量的护理，但许多儿童在当前系统下没有得到适当的治疗。我们打算从电子健康记录中建立一个数据登记处，以收集和报告向儿童提供的紧急护理的质量措施。我们将建立可衡量的基准，并实施临床医生的反馈干预，以提高性能;这个拟议的项目将允许系统和广泛的收集和报告的性能和结果，是至关重要的，让临床医生和紧急护理利益相关者，以改善护理超越当地水平。