Medical Failure-to-Rescue

描述（由申请人提供）：理论和结果测量失败抢救（FTR）被开发来评估医院对外科病人的护理质量。这项建议力求将FTR扩展到医疗状况分析。FTR衡量的是护理人员管理病情变得复杂的患者并使其免于死亡的能力。该措施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几乎只应用于外科病例。自1992年西尔伯首次引入FTR指标以来，该指标已被广泛应用于外科护理质量评估，它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，还是在了解医院或提供者在死亡率指标上表现不佳的原因方面，都从未成功地应用于患有疾病的患者。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“入院时存在”（POA）指标，这可以大大提高分析人员在实施医疗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度量。鉴于公众和卫生政策分析人士对改进质量指标的需求，现在似乎是将这一措施扩展到医疗条件的理想时机。目标1：利用国家医疗保险数据和来自加利福尼亚州的州数据，我们将开发和验证包括心力衰竭、急性心肌梗死和肺炎在内的主要医疗状况的FTR并发症清单。AIM 2：利用AIM 1的结果，为每种医疗状况制定医疗FTR度量，并研究FTR度量的性质。我们将探讨两种类型的FTR率：原始的Silber定义方法（FTR）使用所有并发症和AHRQ方法（a -FTR）使用并发症和死亡的子集，我们将比较所有后续假设的结果。AIM 3：建立医疗FTR和a -FTR的严重程度调整模型；AIM 4：确定医疗FTR指标的信度和效度。总而言之，这项提议将建立一种新的方法，根据“抢救失败”来检查医疗条件的护理质量。我们的目的是将失败抢救分析的优势与外科手术病人的分析相结合，带给医学界。

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.