Pediatric Respiratory Illness Inpatient Measurement System Study

描述(由申请人提供)：护理质量可以通过评估护理的结构、过程或结果来衡量。然而，护理过程的要素在它们与理想结果的关系确定之前并不意味着质量。在儿科学中，很少有研究考察任何特定疾病患者的小样本量和很少发生容易测量的结果(例如死亡)的继发性过程-结果联系。因此，大多数儿科实践指南包括基于专家共识意见的建议，而不是建立推荐护理过程和结果之间联系的科学证据。在许多情况下，我们认为提供符合这些指导方针的护理将产生更好的结果。在国家心肺血液研究所的资助下，我们开发并试点测试了一种严格设计的护理质量评估工具-儿科呼吸系统住院患者测量系统(PRIMES)。Primes是一种质量测量工具，其结构是使用五种呼吸系统疾病的医疗记录数据生成质量分数：哮喘、毛细支气管炎、哮喘、社区获得性肺炎和囊性纤维化肺恶化。该工具评估儿科急诊科(ED)和住院环境中提供的护理过程，其内容主要基于既定的专家共识实践指南。我们建议通过评估工具中包含的护理过程的依从性水平、改善的结果和护理成本之间的关系来对PRIMES进行结果验证研究。使用PRIMES，我们将对住院环境中的儿科研究(PRIS)网络所属的五家美国儿童医院之一的3000名患者的医院管理进行详细评估。我们将在三个时间点使用有效的调查测量来评估健康相关生活质量(HRQOL)的改善：入院前一个月(基线)、入院当天和出院后两周。我们还将评估指数急诊室就诊和住院的护理费用，以及住院时间(LOS)、30天回程急诊室就诊和再次入院的费用。这项拟议的研究将大大增加我们对儿科坚持推荐的护理标准和卫生保健结果之间关系的理解。如果被发现可以预测重要的结果，质数可以用于识别最需要提高质量努力的呼吸系统疾病护理领域，并提供全国护理儿童的医院之间的有效绩效比较。

DESCRIPTION (provided by applicant): Quality of care can be measured by assessing the structure, process, or outcomes of care. However, elements of care processes do not signify quality until their relationship to desirable outcomes has been established. In pediatrics, there are few studies examining the process-outcome link secondary to small sample sizes of patients with any particular condition and the rare occurrence of readily measured outcomes (e.g. death). As a result, most pediatric practice guidelines include recommendations based on expert consensus opinion rather than scientific evidence establishing a link between the recommended care processes and outcomes. In many cases, we assume that providing care consistent with these guidelines will result in better outcomes. Under funding from the National Heart Lung Blood Institute, we have developed and pilot tested a rigorously designed quality of care assessment tool, the Pediatric Respiratory Illness Inpatient Measurement System (PRIMES). PRIMES is a quality measurement tool that is structured to generate quality scores using medical records data for five respiratory conditions: asthma, bronchiolitis, croup, community acquired pneumonia, and cystic fibrosis pulmonary exacerbation. The tool assesses processes of care provided in the pediatric emergency department (ED) and inpatient settings and its content is largely based on established expert consensus practice guidelines. We propose to conduct an outcome validation study of PRIMES by assessing the relationship between level of adherence to the processes of care included in the tool, improved outcomes, and costs of care. Using PRIMES, we will conduct a detailed assessment of the hospital management of 3,000 patients admitted to one of five United States children's hospitals belonging to the Pediatric Research in Inpatient Settings (PRIS) Network. We will assess improvements in health related quality of life (HRQOL) using a validated survey measure at three time points: the month prior to the index admission (baseline), the day of admission, and two weeks after discharge. We will also assess costs of care for the index ED visit and hospital admission as well as length of stay (LOS), 30-day return ED visits, and readmissions. The proposed study will substantially add to our understanding of the relationship between adhering to recommended standards of care in pediatrics and health care outcomes. If found to predict important outcomes, PRIMES could be used to both identify areas of respiratory illness care where quality improvement efforts are most needed and provide valid performance comparisons across hospitals caring for children nationally.