Medical Failure-to-Rescue

描述（由申请方提供）：开发了抢救失败（FTR）的理论和结局指标，以评估外科患者的医院护理质量。该提案旨在将FTR扩展到医疗状况分析。FTR衡量护理人员管理复杂患者并使其免于死亡的能力。该指标取决于分析人员区分并发症和合并症的能力，以及检测并发症的可用数据的完整性。由于难以区分并发症和合并症，FTR几乎仅适用于手术病例。自1992年Silber首次引入FTR以来，已经有许多应用该指标进行外科护理质量评估，并且它已经成为探索医院特征，护理特征和医生特征重要性的有用指标。FTR以多种形式得到了国家质量论坛的认可。不幸的是，FTR指标在改善严重程度调整和深入了解医院或提供者在死亡率指标上表现不佳的原因方面的益处从未成功应用于患有医疗状况的患者。然而，自1992年首次开发FTR以来，分析师可用的数据集发生了根本性的变化。医疗保险索赔数据现在为所有诊断提供了一个“入院时在场”（POA）指标，这可以大大提高分析师在实施医疗FTR分析时区分并发症和合并症的能力。因此，现在有可能开发和验证医学FTR指标。考虑到公众和卫生政策分析师对改进质量指标的需求，现在似乎是将该措施扩展到医疗条件的理想时机。该项目有四个目标：目标1：使用国家医疗保险数据和来自加州的州数据，我们将开发并验证主要医疗状况（包括CHF、AMI和肺炎）的FTR并发症列表。目的2：使用目的1的结果，为每种医疗条件制定医疗FTR指标，并研究FTR指标的属性。我们将探索2种类型的FTR率：使用所有并发症的原始Silber定义方法（FTR）和使用并发症和死亡子集的AHRQ方法（A-FTR），我们将比较所有后续假设的结果。目标3：为医学FTR和A-FTR开发严重度调整模型，最后，目标4：确定医学FTR指标的可靠性和有效性。总之，该提案将建立一种新的方法来检查基于抢救失败的医疗条件的护理质量。我们的目的是为医学界带来的优势，使用失败的抢救分析，以平行的方式对手术患者。

DESCRIPTION (provided by applicant): The theory and outcome measure Failure-to-Rescue (FTR) was developed to assess hospital quality of care for surgical patients. This proposal seeks to extend FTR to the analysis of medical conditions. FTR measures the ability of caregivers to manage a patient who becomes complicated and keep them from dying. The measure depends on the ability of the analyst to differentiate complications from comorbidities and on the completeness of the available data in detecting complications. Due to difficulties in distinguishing complications from comorbidities, FTR has been applied almost exclusively to surgical cases. Since the metric FTR was first introduced by Silber in 1992, there have been many applications of the metric for quality assessment of surgical care, and it has been a useful metric for exploring the importance of hospital characteristics, nursing characteristics, and physician characteristics. FTR has been endorsed in multiple forms by the National Quality Forum. Unfortunately, the benefits of the FTR metric, both with respect to improving severity adjustment and gaining insight into why a hospital or provider may be performing poorly on mortality metrics, have never been successfully applied to patients with medical conditions. However, there has been a radical change in the data sets available to analysts since 1992 when FTR was first developed. Medicare claims data now provide a "present on admission" (POA) indicator for all diagnoses, which could greatly improve the ability of analysts to distinguish complications from comorbidities when implementing a medical FTR analysis. Therefore, it is now possible to potentially develop and validate a medical FTR metric. Given the demand for improved quality metrics by both the public and health policy analysts alike, it would seem like an ideal time to extend the measure to medical conditions. This project has 4 aims: AIM 1: Using national Medicare data and state data from California, we will develop and validate a list of FTR complications for major medical conditions including CHF, AMI, and Pneumonia. AIM 2: Using results from AIM 1, develop a medical FTR metric for each medical condition and study the properties of the FTR metric. We will explore 2 types of FTR rates: The original Silber defined approach (FTR) using all complications and the AHRQ approach (A-FTR) using a subset of complications and deaths, and we will compare results for all subsequent hypotheses. AIM 3: Develop a severity adjustment model for medical FTR and A-FTR, and finally, AIM 4: Determine the reliability and validity of the medical FTR metric. In summary, this proposal will establish a new approach to examining quality of care for medical conditions based on Failure-to-Rescue. Our intent is to bring to the medical community the advantages of using a failure-to-rescue analysis in a parallel manner to surgical patients.