Understanding the drivers of hospital performance for in-hospital cardiac arrest

描述（由申请人提供）：背景：美国国立卫生研究院的一项重要任务是预防美国人过早的心血管死亡，然而，为什么一些医院心脏骤停后的存活率很高，而另一些医院的存活率却令人担忧，这一点仍然未知。住院心脏骤停（IHCA）是一个重大负担，据估计，美国每年有20万住院患者发生心脏骤停。值得关注的是，结果很差，IHCA后的存活率差异很大，各医院的存活率从1-40%不等。医院之间的这种差异表明，如果我们能更好地了解影响预后的关键因素，就有机会改善住院患者的护理和生存率。目的：本建议的重点是确定院内骤停生存率高和低的医院以及最能预测IHCA结果的因素。研究设计和方法：本提案的具体目标是：目标1：建立患者水平的IHCA风险调整生存率模型方法：使用现有注册表的数据进行回顾性多中心队列研究，计算IHCA风险调整生存率。目的2：确定IHCA生存率的可测量的医院预测因素方法：建立一个包含患者和医院水平变量的IHCA结果的层次回归模型。然后，使用风险调整生存率根据IHCA结果高低对医院进行分层。目标3：调查来自医院登记的关键信息提供者，以确定心脏骤停管理的过程措施与IHCA存活率之间的关系。方法：进行文献综述和半结构化访谈，以告知调查的发展。对复苏规范委员会主任的一个子集（在IHCA存活率高和低的医院）进行调查，并分析调查数据，以评估IHCA过程措施如何与结果相关联。长期目标：该项目将为未来的研究奠定基础，这些研究旨在开发、验证和实施以患者为导向的IHCA护理绩效指标。这些绩效指标对于患者评估医院、医院管理人员制定患者安全和质量改进举措以及参与公开报告的政策制定者具有重要意义。

DESCRIPTION (provided by applicant): Background: An important mission of the NIH is to prevent premature cardiovascular deaths of Americans, yet it remains unknown why some hospitals have good survival rates after cardiac arrest while other hospital survival rates remain worrisome. In-hospital cardiac arrest (IHCA) represents a significant burden as an estimated 200,000 arrests occur in hospitalized patients in the United States annually. Of concern, outcomes are poor and survival rates after IHCA vary significantly, from 1-40% across hospitals. This variability among hospitals suggests an opportunity to improve care and survival rates of hospitalized patients if we can better understand the factors that critically impact prognosis. Objective: The focus of this proposal is to identify hospitals with high and low in-hospital arrest survival rates and the factors which most closely predict IHCA outcomes. Study design and Methods: The specific aims for this proposal are: Aim 1: Develop a patient level model of risk-adjusted IHCA survival rates Approach: Conduct a retrospective multicenter cohort study using data from an existing registry to calculate IHCA risk-adjusted survival rates. Aim 2: Identify measurable hospital predictors of IHCA survival rates Approach: Develop a hierarchical regression model of IHCA outcomes with patient and hospital level variables. Then, use risk-adjusted survival rates to stratify hospitals by high and low IHCA outcomes. Aim 3: Survey key informants from a registry of hospitals to determine how process measures for cardiac arrest management are associated with IHCA survival rates. Approach: Conduct a literature review and semi-structured interviews to inform the development of a survey. Administer the survey to a subset of resuscitation code committee directors (at hospitals with high and low IHCA survival rates) and analyze the survey data to assess how IHCA process measures are associated with outcomes. Long term objective: This project will lay the groundwork for future studies geared towards development, validation, and implementation of patient-oriented performance measures for IHCA care. These performance measures will have significant relevance for patients evaluating hospitals, hospital administrators developing patient safety and quality improvement initiatives, and policy makers involved in public reporting.