GEOGRAPHIC VARIABILITY IN EMERGENCY DEPARTMENT USE FOR PEDIATRIC ASTHMA

描述(由申请人提供)： Jon Mark Hirshon，医学博士，M.P.H.，急诊医学和预防医学认证委员会，寻求流行病学博士学位，以获得连接、操作和分析大型数据库的高级技能。这位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地点。此应用程序的目的是分析马里兰州的数据，以确定马里兰州内急诊科对哮喘的利用是否存在地理差异。然后，他计划开发一个多变量模型，该模型结合了社会人口学变量和环境因素，以评估哪些风险修饰物影响使用ED治疗哮喘。由于需要寻求紧急医疗护理是哮喘患者的前哨事件，更好地了解与ED使用相关的变量将进一步关注与哮喘恶化相关的基于人群的研究。具体的研究目标是：1)按地区量化与哮喘相关的急诊室就诊率；2)量化使用量的变异性是医院编码做法差异的人为因素的程度；3)开发一个结合环境因素(如每个县的空气污染物标准)和社会人口变量(如新住房建设)的模型，以评估影响使用急诊室治疗哮喘风险的原因。还没有将多个全州范围的数据来源联系起来，以评估寻求哮喘紧急医疗护理的需求的地理变异性。马里兰州是研究基于人口的数据的绝佳地点，因为：1)全州范围内的多个医疗保健、环境和社会人口数据库；2)反映美国境内多样性的地理和人口变异性；以及3)其相对较小的面积。这项研究将使我们能够更好地了解马里兰州的教育利用差异，同时进一步评估这些差异是否具有特定的环境和社会人口影响因素。考虑到其丰富的研究资源，马里兰大学是进行这项研究的理想环境。这项研究可能在全国范围内适用，并可能导致创新战略，以满足2010年健康人目标24-3，重点是减少哮喘患者对ED的使用。

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.