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（OHCA）是美国的主要死亡原因，每年影响约30万公民。OHCA患者的最佳管理涉及一种整体人群健康方法，该方法涉及公共卫生系统（使用自动体外除颤器）、院外护理（紧急医疗服务的快速响应，将患者送往心脏复苏中心的明确目的地协议）和院内护理（快速获得高容量心导管插入术，低温诱导协议）。OHCA的管理和结果存在明显的地理差异，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）最近将总人口健康定义为“生活在特定地缘政治区域的所有人的健康”，并要求公共卫生和医疗保健社区合作改善人口健康。在这项提案中，我们描述了一个计划，以开发新的空间方法，将调整激励参与OHCA患者管理的许多利益相关者。我们的工作将实现三个目标：目标1。描述OHCA患者使用医院的现有模式。为此，我们将使用来自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到医院的地理流量。目标2.根据经验确定现有的心脏骤停医院联盟及其地理覆盖区（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经验发生的医院集群的基础上重叠的病人， 利用模式，识别最佳聚类解决方案（联盟），并确定每个联盟的相应地理服务区域（心脏骤停服务区域）。目标3。确定心脏骤停服务领域中风险调整生存率的变异性。在我们的最终目标中，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。我们将探讨OHCA中个人、社区、公共卫生、院外和院内因素的相对重要性，并将对心脏骤停服务领域的结果进行基准测试。这项工作有能力从根本上改变OHCA的管理，通过在一个统一的负责任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。我们的方法是可复制的，可扩展的，并与IOM的总人口健康的愿景和美国心脏协会的努力，建立OHCA的护理区域系统一致。

 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.