Medical Failure-to-Rescue

描述(由申请人提供)：理论和结果衡量失败-抢救(FTR)是为了评估医院对外科患者的护理质量。这项提议旨在将FTR扩展到医疗条件的分析。FTR衡量的是照顾者管理复杂患者并使他们免于死亡的能力。衡量标准取决于分析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几乎只应用于外科病例。自1992年Silber首次引入FTR指标以来，该指标在外科护理质量评估中得到了广泛的应用，并已成为探索医院特征、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指标的好处，无论是在改善严重程度调整方面，还是在洞察为什么医院或提供者在死亡率指标上表现不佳方面，都从未成功地应用于有医疗条件的患者。然而，自1992年首次开发FTR以来，分析师可获得的数据集发生了根本性的变化。联邦医疗保险索赔数据现在为所有诊断提供了“入院时在场”(POA)指标，这可以极大地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疗FTR指标。鉴于公众和卫生政策分析师都要求改进质量指标，现在似乎是将该指标扩展到医疗条件的理想时机。该项目有4个目标：目标1：使用国家医疗保险数据和加利福尼亚州的州数据，我们将开发和验证主要医疗条件下的FTR并发症清单，包括心力衰竭、急性心肌梗死和肺炎。目的2：使用AIM 1的结果，为每种医疗条件制定医疗FTR度量，并研究FTR度量的性质。我们将探索两种类型的FTR比率：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的子集的AHRQ方法(A-FTR)，我们将比较所有后续假设的结果。目的3：建立医疗FTR和A-FTR的严重程度调整模型，最后，目的4：确定医疗FTR测量的信度和效度。综上所述，这项提案将建立一种新的方法，以检查基于未能抢救的医疗条件的护理质量。我们的目的是为医学界带来与手术患者并行使用失败抢救分析的优势。

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.