Hospital Volume and Induction Mortality in Children, Adolescents, and Young Adult

描述（由申请人提供）：研究儿童白血病的住院量与死亡率之间的关系，特别是青春期和青年期的高危年龄。目标1：检查儿科肿瘤量与儿科急性白血病（0-15岁）诱导治疗中校正的病死率之间的关系。目标二：检查儿童急性白血病（0-15岁）诱导治疗中儿童总体积与校正病死率之间的关系。目标3：在青少年和年轻成人（AYA;年龄15- 29岁）急性白血病诱导治疗中，检查a）总体儿科体积，B）儿科肿瘤体积与校正的病死率之间的相关性。相关性：按照AHRQ的承诺，以提高医疗保健的质量和有效性，在儿童和年轻成人白血病的数量和结果之间的关系将确定可能的群体的机构与高和低死亡率。这些集群的识别将有助于进一步的工作，以确定机构之间的死亡率变化的病因，并确定在低死亡率机构的最佳做法。研究方法：我们将使用两个比较性管理数据库：儿科健康信息系统（PHIS）和Premier Perspectives数据库（Premier）进行多位点队列研究。我们将从PHIS和Premier中识别所有新诊断的ALL和AML患者，并确定诱导治疗期间的住院死亡率。将使用混合效应logistic回归模型进行主要调整分析，同时考虑到医院的聚类。研究培训计划：该申请人将进行从设计到统计分析的具体目标的所有方面，以获得设计、数据质量和分析以及未来研究准备方面的额外经验。额外的专业知识将通过成果研究和系统审查和荟萃分析的课程开发，为提交辅导职业发展奖（K-23）做准备。

DESCRIPTION (provided by applicant): To examine the relationship between hospital volume and mortality in pediatric leukemia, particularly the at-risk ages of adolescence and young adulthood. Aim1: Examine the association between pediatric oncology volume and adjusted case fatality rates in induction in pediatric acute leukemia (ages 0-15 years). Aim 2: Examine the association between overall pediatric volume and adjusted case fatality rates in induction in pediatric acute leukemia (ages 0-15 years). Aim 3: Examine the associations between a) overall pediatric volume, b) pediatric oncology volume with adjusted case fatality rates in adolescent and young adult (AYA; ages 15- 29 years) induction therapy for acute leukemia. Relevance: In accordance with AHRQ's commitment to improve the quality and effectiveness of health care, the relationship between volume and outcome in pediatric and young adult leukemia will identify likely groups of institutions with high and low mortality. Identification of these clusters will alow for further work to determine the etiology of the variation of mortality between institutions and identification of best practices at low mortality institutions. Methods: We will conduct a multi-sie cohort study using two comparative administrative databases: Pediatric Health Information System (PHIS) and Premier Perspectives Database (Premier). We will identify all newly diagnosed ALL and AML patients from PHIS and Premier, and ascertain in-hospital mortality during induction therapy. Primary adjusted analysis will be undertaken using mixed effects logistic regression model taking into account the clustering by hospital. Research Training Plan: This applicant will conduct all aspects of the specific aims from design through statistical analysis for additional experience in design, data quality and analysis and preparation of future studies. Additional expertise will be developed through coursework in outcomes research and systematic review and meta-analysis in preparation for submission of a Mentored Career Development Award (K-23).