A population based approach to improve outcomes after out-of hospital cardiac arrest

 描述(由申请人提供)：院外心脏骤停是美国的一个主要死亡原因，每年影响大约30万公民。最佳的治疗包括公共卫生系统(可使用自动体外除颤器)、院外护理(紧急医疗服务的快速反应、明确的目的地方案以将患者送往心脏复苏中心)和院内护理(快速获得大容量心导管、低温诱导方案)。HCA的管理和结果存在明显的地域差异，领先的专业协会支持心脏骤停护理系统的发展。医学研究所(IOM)最近将总体人口健康定义为“生活在特定地缘政治地区的所有人的健康”，并要求公共卫生界和医疗保健界共同努力，改善人口健康。在这项提案中，我们描述了一项开发新的空间方法的计划，该方法将协调对许多利益相关者的激励，这些利益相关者参与了ol A患者的管理。我们的工作将在三个目标上实现：目标1。描述现有的医疗室利用模式。在这一目标中，我们将使用医疗保险和医疗补助服务中心的地理编码索赔数据来衡量患者前往医院的地理流量。目的2.确定经验性存在的心脏骤停医院联盟及其地理范围(心脏骤停服务区)。在这个目标中，我们将使用空间聚类分析来定义基于重叠患者的经验发生的医院集群 利用模式，确定最佳的集群解决方案(联盟)，并为每个联盟确定相应的地理集水区(心脏骤停服务区)。目的3.确定心脏骤停服务区风险调整后存活率的变异性。在我们的FINA目标中，我们将开发和校准风险调整模型，以比较心脏骤停服务领域的结果。我们将探索在个人、社区、公共卫生、医院外和医院内水平上的因素对uchA的相对重要性，并将对心脏骤停服务领域的结果进行基准测试。这项工作有能力通过在统一负责的护理单位内协调多个利益相关者的激励措施，促进心脏骤停护理系统的发展，从而从根本上改变uchA的管理。我们的方法是可复制、可扩展的，并与国际移民组织关于总体人口健康的愿景和美国心脏协会为建立区域护理系统而对ol A进行的努力保持一致。

 DESCRIPTION (provided by applicant): Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the United States, affecting approximately 300,000 citizens annually. The optimal management of patients with OHCA involves a total population health approach that engages the public health system (access to automatic external defibrillators), out-of-hospital care (prompt response of emergency medical services, clear destination protocols to take patients to cardiac resuscitation centers), and in-hospital care (rapid access to high volume cardiac catheterization, hypothermia induction protocols). Marked geographic variability exists in the management and outcomes of OHCA, and leading professional societies have supported the development of cardiac arrest systems of care. The Institute of Medicine (IOM) recently defined total population health as "the health of all persons living in a specified geopolitical area," and challenged the public health and healthcare communities to work collaboratively to improve the health of the population. In this proposal, we describe a plan to develop new spatial methods that will align incentives for the many stakeholders involved in the management of patients with OHCA. Our work will be achieved in three aims: Aim 1. Describe the existing patterns of hospital utilization for patients with OHCA. In this aim we will use geocoded claims data from the Centers for Medicare & Medicaid Services to measure the geographic flow of patients to hospitals. Aim 2. Identify empirically existing cardiac arrest hospital coalitions and their geographic catchment areas (cardiac arrest service areas). In this aim, we will use spatial cluster analysis to define empirically occurring clusters of hospitals based on overlapping patient utilization patterns, identify an optimal clustering solution (a coalition), and determine the corresponding geographic catchment area for each coalition (a cardiac arrest service area). Aim 3. Determine variability in risk-adjusted survival across cardiac arrest service areas. In our fina aim, we will develop and calibrate risk adjustment models to compare outcomes across cardiac arrest service areas. We will explore the relative importance of factors at the individual, community, public health, out-of-hospital, and in-hospital level on OHCA and will benchmark outcomes across cardiac arrest service areas. This work has the ability to fundamentally alter the management of OHCA, through facilitating the development of cardiac arrest systems of care by aligning incentives across multiple stakeholders within a unified accountable unit of care. Our methods are replicable, scalable, and consistent with the IOM's vision of total population health and the American Heart Association's efforts to build regional systems of care for OHCA.