The geography of acute care

 描述(由申请人提供)：开创性的联邦计划，包括CMS的质量倡议和AHRQ的质量和安全组合，提高了透明度，改善了医疗保健的价值。患者保护和平价医疗法案已将社区和人口健康列为质量运动的关键下一步。因此，国家质量论坛和医学研究所将重点放在了解如何最好地改善人口健康上，卫生与公众服务部制定了国家质量战略。虽然从概念上定义了人口健康，但没有定义可问责的地理单位，因此无法衡量和比较各社区健康指标的标准化衡量。这项建议的总体目标是经验性地得出新的卫生保健联盟及其相应的可用于衡量实现人口健康的进展的范围。我们将使用现有的动态护理敏感条件(ACSC，称为预防质量指标)、即将发布的急诊部预防质量指标，以及一些紧急护理敏感条件(ECSC)来描绘医疗系统对人口急性医疗需求的管理的令人信服的肖像。我们将首先确定医疗保健联盟(HCC)及其相应的地理集水区，它们在经验上代表了全美的急性医疗保健利用率。然后，我们将评估医疗保健联盟(HCC)检测健康指标有意义的可变性的能力，以促进联盟之间的比较报告。最后，我们将衡量医疗保健联盟中预防质量指标的可变性，并公开传播医疗联盟和集水区的统计代码和地理形状文件。共享来自重叠社区的患者的医疗机构对那些在需要的时候向他们寻求帮助的人的需求负有共同的责任。到目前为止，很难衡量地方和区域向民众提供的护理质量。 医疗保健服务系统。这里提出的工作将开发一个经验性定义的地理“分母”，描述医院集团为其分担人口健康责任的人口，这项工作将促进跨部门卫生系统的合作。

 DESCRIPTION (provided by applicant): Groundbreaking federal programs including CMS's quality initiatives and AHRQ's quality and safety portfolio have increased transparency and improved the value of healthcare. The Patient Protection and Affordable Care Act have prioritized community and population health as the critical next step in the quality movement. As a result, the National Quality Forum and the Institute of Medicine have focused efforts on understanding how best to improve population health, and the Department of Health & Human Services has created a National Quality Strategy. While population health has been defined conceptually, no accountable geographic unit has been defined and thus standardized measurement of health indicators across communities cannot be measured and compared. The overall goal of this proposal is to empirically derive novel health care coalitions and their corresponding catchments that can be used to measure progress toward the achievement of population health. We will use existing Ambulatory Care Sensitive Conditions (ACSC, called Prevention Quality Indicators), the soon to be released Emergency Department Prevention Quality Indicators, and a number of Emergency Care Sensitive Conditions (ECSC) to paint a compelling portrait of the healthcare system's management of the population's acute healthcare needs. We will first identify healthcare coalitions (HCC) and their corresponding geographic catchments that empirically represent acute healthcare utilization across the United States. Then, we will evaluate the ability of healthcare coalitions (HCC) to detect meaningful variability of health indicators to facilitate comparative reporting between coalitions. Finally, we will measure variability in prevention quality indicators across healthcare coalitions and publicly disseminate statistical code and geographic shapefiles for healthcare coalitions and catchments. Healthcare facilities that share patients from overlapping neighborhoods have a shared responsibility for the needs of those who look to them in their time of need. To date, it has been difficult to measure the quality of care delivered to the population by local and regional healthcare delivery systems. The work proposed here will develop an empirically defined geographic "denominator" that describes the population for which groups of hospitals share the responsibility of population health, and this work will facilitate cooperation across the multisectoral health system.