Unexpected death after medical encounters: Measurement, reporting, and analysis

描述（由申请人提供）：在美国急诊科每年就诊的1.2亿患者中，85%出院回家，在门诊就诊的10亿患者中绝大多数也是如此。虽然医院内的死亡率是常规测量和报告的，但由于医疗保健组织内部和之间的医疗信息系统支离破碎，因此在医疗机构外的死亡率更难以捕捉。因此，医疗服务提供者没有系统的方法来了解病人在被送回家后何时意外死亡，政策制定者也无法轻易衡量这些灾难性事件发生的频率。我提出了一系列相关的研究项目来跟踪和分析医疗事故后的意外死亡，使用来自大型学术医院系统以及医疗保险索赔的数据，以确定与个体患者，提供者和系统相关的因素，这些因素增加了此类事件的可能性。随后，我将调整方法，以适应国际环境，其中临床和管理数据不如美国完整。这项工作将有重要的意义，改善临床护理和卫生服务的设计。此外，采用系统的方法跟踪和报告意外早死率，将是衡量保健服务业绩和评估质量与成本之间权衡的一个有用方法。 公共卫生相关性：每年在急诊设施或诊所就诊的11亿患者中，大多数人在就诊后返回家中，但医生和政策制定者都没有这样做。 一种系统的方法来识别那些在被送回家后意外死亡的病人。我的项目旨在跟踪和分析这些事件，目的是帮助提供者识别高风险患者;了解使风险评估更有可能出错的卫生系统因素;并探索出院后意外死亡率是否可用于衡量和公开报告卫生服务提供的护理质量。

DESCRIPTION (provided by applicant): Of the 120 million patients seen annually in US Emergency Departments, 85% are discharged home, as are the vast majority of the one billion patients seen in ambulatory clinics. While rates of in-hospital deaths are routinely measured and reported, deaths outside of health facilities are far more challenging to capture because of fragmented health information systems both within and among health care organizations. As a result, providers have no systematic way of knowing when a patient dies unexpectedly after being sent home, and policy makers cannot readily measure how frequently these catastrophic events occur. I propose a series of linked research projects to track and analyze unexpected deaths after medical encounters, using data from a large academic hospital system as well as Medicare claims, in order to identify factors related to individual patients, providers, and system that increase the likelihood of such events. I will subsequently adapt the methods to an international setting, where clinical and administrative data are less complete than in the US. This work would have important implications for improving both clinical care and health services design. In addition, a systematic method for tracking and reporting rates of unexpected early deaths would be a useful way to measure health services performance, and assess trade-offs between quality and cost. PUBLIC HEALTH RELEVANCE: Most of the 1.1 billion patients seen annually in emergency facilities or clinics return home after their visit, but neither doctors nor policy makers have any systematic way of identifying patients who die unexpectedly after being sent home. My project aims to track and analyze these events, with the goals of helping providers identify high-risk patients; understanding the health system factors that make errors of risk assessment more likely; and exploring whether rates of unexpected death after discharge can be used to measure and publicly report on the quality of care delivered by health services.