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

描述（由申请人提供）：背景：NIH的一项重要使命是预防美国人的心血管过早死亡，但仍不清楚为什么有些医院在心脏骤停后有良好的生存率，而其他医院的生存率仍然令人担忧。院内心脏骤停（IHCA）是一个巨大的负担，因为在美国每年估计有20万例住院患者发生心脏骤停。值得关注的是，结果很差，IHCA后的生存率差异很大，各医院的生存率从1-40%不等。医院之间的这种差异性表明，如果我们能够更好地了解严重影响预后的因素，就有机会改善住院患者的护理和生存率。目的：该提案的重点是确定具有高和低院内骤停存活率的医院以及最接近预测IHCA结果的因素。研究设计和方法：该提案的具体目标是：目标1：开发风险调整后的IHCA生存率的患者水平模型方法：使用现有登记研究的数据进行回顾性多中心队列研究，以计算IHCA风险调整后的生存率。目标二：确定可测量的医院预测的IHCA生存率的方法：开发一个分层回归模型的IHCA结果与患者和医院水平的变量。然后，使用风险调整后的生存率，按照高和低的IHCA结果对医院进行分层。目标3：调查来自医院登记处的关键信息提供者，以确定心脏骤停管理的流程措施如何与IHCA生存率相关。方法：进行文献综述和半结构化访谈，为调查的发展提供信息。对一部分复苏规范委员会主任（在具有高和低IHCA存活率的医院）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。长期目标：该项目将为今后的研究奠定基础，面向发展，验证和实施以病人为导向的绩效指标的IHCA护理。这些绩效指标将对患者评估医院、医院管理者制定患者安全和质量改进计划以及参与公共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.