Enhancing Hawaii Hospital Information Content

描述（由申请人提供）：对比较有效性研究（CER）的兴趣是基于这样一种信念，即关于卫生保健资源使用的更明智的决策可以改善公众的健康并降低护理成本。虽然CER包含广泛的方法学方法和数据源，但本提案的目标是通过提高夏威夷全州范围内所有付款人医院出院和急诊部门数据集所含数据的广度和范围来发展执行CER的能力。夏威夷是美国种族最多样化的人口、最长的预期寿命、拥有雇主授权医疗福利最长的经验（超过35年），以及每位受益人最低的医疗保险费用之一。本研究的目的是：1）用住院相关的实验室结果补充行政出院数据，这一增强已被证明可以改善住院死亡率和手术并发症的估计，以及疾病严重程度和临床表现的测量; 2）在我们开发主患者标识符（MPI）的初步工作的基础上，将全州各医院的患者联系起来，通过将我们的工作扩展到包括新生儿，并创建一个程序，该程序将自动为全州数据库中接收的所有新患者记录分配MPI;以及3）通过执行比较有效性研究来证明增强数据库的可行性和有用性，该研究将检查护理的结果（例如，住院时间、费用、院内死亡、30天内再次入院）。 公共卫生相关性：有一个显着的需要，以产生全面的信息，这将有助于医疗保健专业人员，病人，和他们的家人作出更明智的医疗保健决定。我们计划通过增加实验室结果和完成一种跟踪全州医院就诊患者的方法来增强全州范围内所有付费医院出院数据库的内容。我们还将使用这个增强的数据集来评估由住院医生治疗的患者的护理结果-专门从事住院医学和为初级保健医生管理住院患者护理的医生-与非住院医生治疗的患者相比。

DESCRIPTION (provided by applicant): The interest in comparative effectiveness research (CER) is based on the belief that more informed decisions about the use of health care resources could improve the public's health and reduce the costs of care. Although CER encompasses a broad range of methodologic approaches and data sources, the goal of this proposal is to develop the capacity to perform CER by enhancing the breadth and scope of data contained within a statewide, all-payer hospital discharge and emergency department data set in Hawaii - the state that has the nation's most racially diverse population, the longest life expectancy, the longest experience with employer-mandated health care benefits (over 35 years), and one of the lowest Medicare costs per beneficiary. The aims of this study are to 1) Supplement administrative hospital discharge data with hospitalization-related laboratory results, an enhancement that has been shown to improve estimates of inpatient mortality and surgical complications, and the measurement of disease severity and clinical performance; 2) Build on our preliminary work developing a Master Patient Identifier (MPI) to link patients across hospitals throughout the state, by extending our work to include newborns, and creating a program that would automatically assign an MPI to all new patient records received into the statewide database; and 3) Demonstrate the feasibility and usefulness of the enhanced database by performing a comparative effectiveness research study that will examine the outcomes of care (e.g., length of stay, cost, in-hospital death, 30-day readmission to any hospital) for patients treated by hospitalists compared with patients treated by non-hospitalists. PUBLIC HEALTH RELEVANCE: There is a significant need to generate comprehensive information that will help health care professionals, patients, and their families make more informed health care decisions. We plan to enhance the content of a statewide, all-payer hospital discharge database by adding laboratory results and completing work on a method to track patients across hospital visits throughout the state. We will also use this enhanced data set to evaluate the outcomes of care for patients treated by hospitalists -- physicians who specialize in inpatient medicine and who manage the care of hospitalized patients for primary care physicians - compared with patients treated by non-hospitalists.