GEOGRAPHIC VARIABILITY IN ED USE FOR PEDIATRIC ASTHMA

描述（由申请人提供）： 乔恩·马克·赫森医学博士M.P.H.在急诊医学和预防医学委员会认证，寻求流行病学博士学位，以获得链接，操作和分析大型数据库的高级技能。候选人的长期目标是将急诊科发展为公共卫生监测和假设驱动研究的重要场所。本申请的目的是分析马里兰州的数据，以确定马里兰州内哮喘急诊利用率是否存在地理差异。然后，他计划开发一个多变量模型，该模型将社会人口统计学变量和环境因素结合起来，以评估哪些风险修饰因子影响ED治疗哮喘的使用。由于寻求紧急医疗护理的需要是哮喘患者的一个前哨事件，因此更好地了解与艾德使用相关的变量将进一步关注与哮喘急性发作相关的基于人群的研究。具体的研究目标是：1）量化各地区哮喘相关艾德就诊率; 2）量化医院编码实践差异造成的利用率差异程度; 3）开发一个模型，其中包括环境因素，如每个县的空气污染标准，和社会人口变量，如新的住房建设，评价影响使用艾德治疗哮喘风险的原因。尚未将多个全州范围的数据源联系起来，以评估哮喘紧急医疗护理需求的地理差异。马里兰州是研究基于人口的数据的绝佳地点，这是由于：1）多个全州范围的医疗保健，环境和社会人口数据库; 2）地理和人口变化反映了美国境内的多样性范围; 3）其相对较小的规模。这项研究将使我们能够更好地了解马里兰州内看到的艾德利用差异，同时进一步评估这些差异的具体环境和社会人口的修饰符。考虑到其丰富的研究资源，马里兰州大学是一个理想的环境进行这项研究。这项研究具有潜在的全国适用性，并可能导致创新的战略，以满足健康的人2010年的目标24-3，重点是减少艾德使用哮喘。

DESCRIPTION (provided by applicant): Jon Mark Hirshon, M.D., M.P.H., Board Certified in both Emergency Medicine and Preventive Medicine, seeks a Doctorate in Epidemiology in order to acquire advanced skills in linking, manipulating and analyzing large databases. The candidate's long-term goal is to develop emergency departments as significant sites for public health surveillance and hypothesis-driven research. The objective of this application is to analyze State of Maryland data to determine whether there is geographic variability in emergency department utilization for asthma within the State of Maryland. He then plans to develop a multiple variable model that incorporates socio-demographic variables and environmental factors to evaluate what risk modifiers impact the use of EDs for asthma. Since the need to seek emergent medical care is a sentinel event for individuals with asthma, a better understanding of variables associated with ED utilization will focus further population based research related to asthma exacerbations. The specific research aims are: 1) quantify rates of asthma-related ED visits by region; 2) quantify the degree to which the amount of utilization variability is an artifact of differences in hospital coding practices; 3) develop a model that incorporates environmental factors, such as criteria air pollutants per county, and socio-demographic variables, such as new housing construction, to evaluate the causes affecting the risk of using the ED for asthma. The linking of multiple statewide data sources to evaluate geographic variability in the need to seek emergent medical care for asthma has not been done. Maryland is a wonderful location to study population-based data due to: 1) the multiple statewide health care, environmental and socio-demographic databases; 2) the geographic and population variability mirroring the range of diversity seen within the United States; and 3) its relatively small size. This research will allow us to obtain a better understanding of the ED utilization differences seen within Maryland, while further evaluating these differences for specific environmental and socio-demographic modifiers. Considering its rich research resources, University of Maryland is an ideal environment to conduct this study. The research has potential nationwide applicability and could lead to innovative strategies to meet the Healthy People 2010 objective 24-3 focused on decreasing ED utilization for asthma.