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

背景：美国国立卫生研究院的一项重要使命是预防美国人心血管疾病的过早死亡，然而，目前尚不清楚为什么一些医院在心脏骤停后存活率很好，而其他医院的存活率仍然令人担忧。住院心脏骤停(IHCA)是一个巨大的负担，因为据估计，美国每年有20万名住院患者发生心脏骤停。令人担忧的是，结果很差，IHCA后的存活率差异很大，不同医院的存活率从1-40%不等。医院之间的这种差异表明，如果我们能够更好地了解影响预后的关键因素，就有机会提高住院患者的护理和存活率。目的：这项建议的重点是确定院内骤停存活率高和低的医院，以及最接近预测IHCA结果的因素。研究设计和方法：这项建议的具体目标是：目标1：建立风险调整的IHCA存活率的患者水平模型方法：利用现有登记的数据进行一项回顾性的多中心队列研究，计算IHCA的风险调整的存活率。目的2：确定IHCA存活率的可测量医院预测因素方法：建立IHCA结果与患者和医院水平变量的分层回归模型。然后，使用风险调整后的存活率根据IHCA结果的高低对医院进行分层。目的3：调查医院登记处的关键信息来源，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：进行文献回顾和半结构化访谈，以了解调查的进展情况。对复苏代码委员会主任的子集进行调查(在IHCA存活率高和低的医院)，并分析调查数据，以评估IHCA流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，以开发、验证和实施以患者为中心的IHCA护理绩效衡量标准。这些绩效衡量标准将对评估医院的患者、制定患者安全和质量改进计划的医院管理人员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.