Unexpected death after medical encounters: Measurement, reporting, and analysis

医疗事故后的意外死亡：测量、报告和分析

• 批准号: 8918327
• 负责人: Ziad Obermeyer
• 金额: $ 32.04万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-25 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8918327
• 关键词: Accident and Emergency department; Arrhythmia; Cardiac; Caring; Case-Control Studies; Cessation of life; Chest Pain; Clinic; Clinical; Clinical Data; Comorbidity; Consensus; Country; Data; Data Analyses; Databases; Diagnostic tests; EFRAC; Economic Factors; Elderly; Emergency Care; Emergency Situation; Emergency department visit; Event; Frequencies; Goals; Health Information System; Health Services; Health care facility; Health system; Healthcare; Home environment; Hospitals; Implantable Defibrillators; Income; Individual; International; Judgment; Linguistics; Link; Location; Measurement; Measures; Medical; Medicare; Medicare claim; Methods; Outpatients; Patients; Performance; Pharmaceutical Preparations; Phase; Physicians; Policy Maker; Population; Provider; Quality of Care; Recording of previous events; Records; Reporting; Research Project Grants; Risk Assessment; Series; Sudden Death; Symptoms; Syncope; System; Test Result; Testing; Training; Unconscious State; United States Social Security Administration; Variant; Visit; Work; administrative database; base; beneficiary; clinical care; cost; design; experience; health care service organization; high risk; improved; novel; social

DESCRIPTION (provided by applicant): Of the 120 million patients seen annually in US Emergency Departments, 85% are discharged home, as are the vast majority of the one billion patients seen in ambulatory clinics. While rates of in-hospital deaths are routinely measured and reported, deaths outside of health facilities are far more challenging to capture because of fragmented health information systems both within and among health care organizations. As a result, providers have no systematic way of knowing when a patient dies unexpectedly after being sent home, and policy makers cannot readily measure how frequently these catastrophic events occur. I propose a series of linked research projects to track and analyze unexpected deaths after medical encounters, using data from a large academic hospital system as well as Medicare claims, in order to identify factors related to individual patients, providers, and system that increase the likelihood of such events. I will subsequently adapt the methods to an international setting, where clinical and administrative data are less complete than in the US. This work would have important implications for improving both clinical care and health services design. In addition, a systematic method for tracking and reporting rates of unexpected early deaths would be a useful way to measure health services performance, and assess trade-offs between quality and cost.

描述(申请人提供)：在每年在美国急诊科就诊的1.2亿名患者中，85%已经出院，在门诊就诊的10亿名患者中，绝大多数都出院了。虽然住院死亡率是定期测量和报告的，但由于卫生保健组织内部和之间的卫生信息系统支离破碎，要统计卫生设施外的死亡人数要困难得多。因此，医疗服务提供者没有系统的方法来了解患者在被送回家后意外死亡的情况，政策制定者也不能轻易衡量这些灾难性事件发生的频率。我提出了一系列相互关联的研究项目，以跟踪和分析医疗事故后的意外死亡，使用来自大型学术医院系统的数据以及医疗保险索赔，以确定与个别患者、提供者和系统相关的因素，这些因素增加了此类事件的可能性。随后，我将使这些方法适应国际环境，在那里，临床和管理数据不如美国完整。这项工作将对改进临床护理和卫生服务设计具有重要意义。此外，跟踪和报告意外过早死亡的比率的系统方法将是衡量卫生服务业绩和评估质量和成本之间权衡的有用方式。