CLINICAL PERFORMANCE MEASURE FOR PEDIATRIC BRAIN INJURY

获得性脑损伤儿童是需要在专业康复医院接受治疗的最大诊断群体。为了认证的目的，这些医院现在需要收集大量患者群体的绩效衡量数据。这项任务提出了一个严重的难题，因为目前儿科康复方面的绩效指标不足以指导内部改进或评估比较绩效。在进行了广泛的文献回顾并咨询了该领域的专家之后，我们在第一阶段设计了一个包含44个项目的原型性能仪器。该工具侧重于脑损伤儿童的三个关键内容领域：1)日常活动，2)社会和行为能力，以及3)社区准备技能。在研究项目的第二阶段，我们将对随机选择的8个机构的患者进行前瞻性调查，修改项目内容，进行信度和效度分析，并制定预期功能水平的风险调整基准。风险调整方法的设计是为了满足卫生组织认证联合委员会批准新文书的要求。第二阶段的最终产品将是一个面向市场的后发性脑损伤儿童的表现测量系统，该系统将满足认证和签约机构的内容和测量要求。拟议的商业应用：这个SBIR项目的产品将是一个具有市场价值的儿童脑损伤表现测量系统。截至1998年，所有JCAHO认可的医院都需要与数据系统签订合同，为大量患者群体提供比较数据。这一绩效指标满足了JCAHO的所有要求，并将填补患者儿科康复项目的关键空白。许多急症护理儿童医院也可能发现这一措施有助于比较直接出院回家的儿童的创伤护理表现。

Children with acquired brain injuries comprise the largest diagnostic group requiring in patient care in specialized rehabilitation hospitals. For accreditation purposes, these hospitals are now required to collect performance measure data for high-volume patient groups. This mandate presents a serious dilemma, since current performance measures in pediatric rehabilitation are inadequate to guide internal improvements or to evaluate comparative performance. After conducting an extensive literature review and consulting experts in the field, in Phase I we designed a 44-item prototype performance instrument. The instrument focuses on three critical content areas for brain-injured children: 1) daily activities, 2) social and behavioral competence, and 3)community readiness skills. In Phase II of the research project, we will conduct a prospective survey of patients in 8 randomly selected facilities, revise the item content, conduct reliability and validity analyses, and develop risk-adjusted benchmarks for expected levels of functioning. The risk adjustment methodology is designed to meet the Joint Commission for the Accreditation of Health Organization's (JCAHO) requirements for approving new instruments. The final product of Phase II will be a marketable performance measurement system for children with acquired brain injury that will meet content and measurement requirements of accreditation and contracting agencies. PROPOSED COMMERCIAL APPLICATIONS: The product of this SBIR project will be a marketable Performance Measurement System for children with Pediatric Brain Injury. As of 1998, all JCAHO accredited hospitals need to contract with a data system to provide comparative data for high-volume patient groups. This Performance Measure meets all the JCAHO requirements and will fill a critical void for in patient pediatric rehabilitation programs. Many acute care children's hospitals may also find this measure helpful in comparing performance of trauma care for children who are directly discharged home.