A Critical Assessment of and Opportunities for Improvement in the Interhospital Transfer of Emergency General Surgery patients

项目总结/摘要 急诊普通外科（EGS）是指对急性非创伤性疾病患者的护理， 需要手术，如憩室炎。近五分之一的EGS患者是从急诊转来的 另一家医院的护理。根据病情严重程度调整后，转移的EGS患者 发病率和死亡率高于直接入院的患者。然而，没有一个有组织的系统 以促进这些转移并可能改善结果。医院之间的优化转移需要 全面和迅速的组织间协调。循证改进协调工作 医院和康复机构之间的护理改善了结果，并有可能受益 EGS患者在急性护理医院之间转移。关系协调是一个既定的概念 研究组织间协调的模型;然而，它尚未被应用于EGS转移 网络，并可能产生重要的干预措施，改善患者的结果。 本项目提出以下目标：1）绘制当前医院间EGS转移系统， 威斯康星州（WI）了解网络结构和“联系强度”（即， 共享患者的数量）和患者结局; 2）探索 转介和接受参与医院间EGS转移的提供者，以更好地了解它们如何影响 护理协调; 3）让关键利益相关者参与全州范围的合作努力，以确定目标的优先次序， 设计一项干预措施，以改善医院间的EGS转移。通过指导研究和职业生涯 凭借丰富的发展经验，英格拉哈姆博士将为领导卫生服务研究（HSR）的职业生涯做好准备 研究护理质量，实践模式和政策评估的计划。她将获得以下方面的专业知识：1） 定量网络分析; 2）定性研究方法; 3）通过 外科合作者; 4）利益相关者参与;和5）负责任的研究行为。 作为一名拥有临床研究硕士学位的急诊普通外科医生，英格拉哈姆博士是独一无二的 胜任这项工作。这项提案填补了教育和职业发展方面的空白，这对确保 通过多学科的指导计划与网络分析，定性和定量专家的独立资助， 研究，护理过渡和关系协调。她得到了有力的研究的支持， 威斯康星州大学的基础设施，外科系在国立研究所中排名第六 卫生基金和WI手术结果研究计划促进合作和成功， 卫生服务研究人员。该奖项满足了紧迫的公共卫生需求，同时提供教育和 导师的研究经验对英格拉哈姆博士领导一个独立的研究项目至关重要。

PROJECT SUMMARY/ABSTRACT Emergency general surgery (EGS) refers to the care of patients with acute, non-traumatic illnesses that may require surgery, such as diverticulitis. Nearly one in five EGS patients is transferred from an emergency department to another hospital for their care. After adjusting for severity of illness, transferred EGS patients experience higher morbidity and mortality than directly admitted patients. However, no organized system exists to facilitate these transfers and potentially improve outcomes. Optimized transfers between hospitals require comprehensive and rapid interorganizational coordination. Evidence-based improvements in the coordination of care between hospitals and rehabilitation facilities have improved outcomes and have the potential to benefit EGS patients transferred between acute care hospitals. Relational Coordination is an established conceptual model to study interorganizational coordination; however, it has not yet been applied to the EGS transfer network and may yield important interventions for improvement in patient outcomes. This project proposes the following aims: 1) Map the current system of interhospital EGS transfers in Wisconsin (WI) to understand the network structure and the association between the “strength of ties” (i.e., number of shared patients) and patient outcomes; 2) Explore the relationships and communication between referring and accepting providers involved in interhospital EGS transfers to better understand how they impact coordination of care; 3) Engage key stakeholders in a statewide collaborative effort to prioritize targets and design an intervention to improve interhospital EGS transfers. Through a mentored research and career development experience, Dr. Ingraham will prepare for a career leading a health services research (HSR) program to study quality of care, practice patterns, and policy evaluation. She will acquire expertise in 1) quantitative network analysis; 2) qualitative research methods; 3) the study of healthcare systems through surgical collaboratives; 4) stakeholder engagement; and 5) responsible conduct of research. As an emergency general surgeon with a master's degree in Clinical Investigation, Dr. Ingraham is uniquely qualified for this work. This proposal fills educational and career development gaps critical to securing independent funding through a multidisciplinary mentored program with experts in network analysis, qualitative research, transitions of care, and Relational Coordination. She is supported by the robust research infrastructure at the University of Wisconsin, where the department of surgery ranks sixth in National Institutes of Health funding and the WI Surgical Outcomes Research Program promotes the collaboration and success of health services researchers. This award meets an urgent public health need while affording the education and mentored research experience critical for Dr. Ingraham to lead an independent research program.