EMERGENCY DEPARTMENT OVERCROWDING AND QUALITY OF ACUTE ASTHMA CARE FOR CHILDREN

描述(由申请人提供)：急诊科(ED)过度拥挤已被证明是普遍的，并影响成人人口的护理质量，尽管还没有研究检查儿童人口过度拥挤与质量的关系。这项拟议的研究的广泛目标是通过以哮喘为疾病模型，在儿科人群中检查ED过度拥挤与护理质量之间的关联，以解决这一文献差距。研究人群将包括所有在三级儿科急诊室接受急性哮喘护理的2-18岁患者。我们将从我们研究人群的电子医疗记录中建立一个数据库，包括患者特征、症状严重程度、过度拥挤程度以及两种类型的质量衡量标准：过程衡量标准和结果衡量标准。提供者特征将从急诊提供者派生并链接到患者数据库。主要的自变量将是儿科急诊室过度拥挤的综合测量。其他自变量将包括患者特征，包括哮喘严重程度评分和提供者特征。过程质量指标将包括给药的及时性和急诊室的住院时间，结果质量指标将包括处置、再次住院、推荐药物的使用和出院教育。 第一组分析将使用Logistic回归和生存分析对关联进行建模 急诊室过度拥挤与每一项过程和结果质量指标之间的关系，患者和 提供者-作为协变量的特征。第二个分析将使用过度拥挤的质量 进一步测试过程度量的中介和患者和提供者特征变量的调节的模型。 了解过度拥挤-质量关系将使研究人员、临床医生和 管理人员更好地衡量、了解和管理那些与过度拥挤相关的因素 与急诊环境中儿科护理质量的变化密切相关。演示了一个 过度拥挤和急诊儿童护理质量下降之间的联系也将呈现出 令人信服的论据，要求改善对急症护理的公共拨款。一种儿科模式链接 急诊室过度拥挤的护理质量因此可以提高卫生保健系统的提供能力 安全、高质量的医疗保健，医疗保健研究和质量机构的第二名 (AHRQ)四个优先领域。因为这项研究集中在一个优先群体--儿童--它还 处理AHRQ评估弱势群体护理质量的任务。

DESCRIPTION (Provided by Applicant): Emergency department (ED) overcrowding has been shown to be widespread, and to affect quality of care in adult populations, although no studies have examined the overcrowding-quality association in a pediatric population. The broad objective of the proposed study is to address this literature gap by examining the association between ED overcrowding and quality-of-care in a pediatric population, using asthma as the disease model. The study population will include all patients aged 2-18 years presenting for acute asthma care at a tertiary care pediatric ED. A database will be constructed from the electronic medical records of our study population, including patient characteristics, symptom severity, overcrowding measures, and two types of quality measures: process measures and outcome measures. Provider characteristics will be derived from the ED providers and linked to the patient database. The primary independent variable will be a composite measure of pediatric ED overcrowding. Other independent variables will include patient characteristics, including asthma severity score, and provider characteristics. Process quality measures will include timeliness of medication administration and ED length-of-stay, and outcome quality measures will include disposition, readmission, use of recommended medications, and discharge education. The first set of analyses will use logistic regression and survival analysis to model the association between ED overcrowding and each of the process and outcome measures of quality, with patient and provider-characteristics as covariates. The second analyses will use the overcrowding-quality models to further test for mediation by process measures and moderation by patient- and provider characteristics variables. Understanding the overcrowding-quality relationship will allow researchers, clinicians, and administrators to better measure, understand and manage those overcrowding-related factors most strongly associated with variations in quality of pediatric care in an ED setting. Demonstration of an association between overcrowding and decreased quality of ED care for children will also present a compelling argument for improved allocation of public funding for ED care. A pediatric model linking ED overcrowding to quality of care can thereby improve the health care system's ability to deliver safe, high quality health care, the second of the Agency for Healthcare Research and Quality's (AHRQ) four priority areas. Because the study centers on a priority population-children-it also addresses the AHRQ mission of assessing the quality of care for vulnerable populations.