Advancing Health Policy and Systems Approaches to Improved Delivery of Surgical Limb Salvage Procedures for Severe Chronic Wounds

项目摘要/摘要 在美国，240万至450万人患有慢性下肢创伤，造成 卫生系统每年高达317亿美元。截肢的减少需要多学科的方法 在严重创伤中，由于非创伤性截肢会导致50%-75%的5年死亡率。一直以来 表明肢体保肢中心的建立降低了截肢率，提高了提供 提供者教育导致更早的转介，改善预防措施并增加全球职能 病人的数量。 目前，人们对美国医院采用保肢手术的情况知之甚少， 包括最常用的手术方式，它们在不同地区和不同时间的传播情况，以及 相对于以社区为基础的需求的业务规模。关于这种护理是如何组织的，更是知之甚少 在当地医院市场内，以及这些市场的结构如何影响哪些患者接受肢体 抢救与截肢。这种基础知识的缺乏是改善 组织和分配资源密集型伤口护理团队，以治疗美国的慢性伤口 结果，肢体保肢手术的特点是交付零散，提供不公平，质量标准很少，以及 普遍的服务费支付机制，众所周知，它们缺乏对质量或效率的激励。 在新冠肺炎大流行期间，这些问题可能会变得更加重要，因为护理的延误可能会导致 在寻求治疗之前，更多的患者出现严重的慢性伤口。 该项目将通过对肢体保全进行第一次大规模评估来解决这些差距。 在美国，下肢创伤的扩散、供应和市场效应。在目标1下，将使用 2005-2017医疗费用和利用项目(HCUP)-国家住院患者数据库(SID)链接到 美国医院年度(AHA)调查，以检查医院市场结构、医院因素和 采用和推广保肢手术中的患者因素及其对护理差异的影响。 在目标2下，我们将聘请一个专家咨询小组，帮助将目标1的结果转化为一套 可操作的卫生系统和政策战略，向从业者传播研究结果，并开展研究 推进亟需的医疗保健支付和提供改革的议程 慢性伤口护理。这项研究将推动AHRQ优先推广循证做法并发展 解决其他优先事项的基础，包括系统和提供商的比较性能，以及 制定业绩改进激励措施。这些发现将对AHRQ特别重要 重点人群，包括低收入、少数民族、农村和慢性病患者。

PROJECT SUMMARY/ABSTRACT In the United States, 2.4-4.5 million people suffer from chronic lower extremity wounds, costing the health system up to $31.7 billion annually. A multidisciplinary approach is necessary for amputation reduction in severe wounds, as nontraumatic amputation leads to a 5-year mortality rate of 50-75%. It has been demonstrated that the establishment of limb salvage centers reduces amputation rates, improves provider to provider education resulting in earlier referral, improves prevention measures and increases global functioning of patients. Currently, little is known about the state of limb salvage adoption by hospitals in the United States, including which surgical modalities are most commonly used, their spread across regions and over time, and the scale of operations relative to community-based need. Even less is known about how this care is organized within local hospital markets and how the structure of these markets affects which patients receive limb salvage versus amputations. This lack of fundamental knowledge stands as a barrier to improvements in the organization and distribution of resource-intensive wound care teams to treat chronic wounds in the U.S. As a result, limb salvage is characterized by fragmented delivery, inequitable provision, few quality standards, and pervasive fee-for-service payment mechanisms with their well-known lack of incentives for quality or efficiency. These issues are likely to grow in importance during the COVID-19 pandemic, as delays in care will likely lead to more patients developing severe chronic wounds before seeking treatment. This project will address these gaps by conducting the first large-scale assessment of limb salvage spread, provision, and market effects for lower extremity wounds in the United States. Under Aim 1, will use the 2005-2017 Healthcare Cost and Utilization Project (HCUP) – State Inpatient Database (SID) linked to the American Hospital Annual (AHA) Survey to examine the role of hospital market structure, hospital factors, and patient factors in the adoption and spread of limb salvage procedures and its effects on disparities in care. Under Aim 2, we will engage an Expert Advisory Panel to help translate the findings from Aim 1 into a set of actionable health system and policy strategies, disseminate findings to practitioners, and develop a research agenda for advancing much-needed healthcare payment and delivery reforms in the provision of severe chronic wound care. This study will advance AHRQ’s priority to spread evidence-based practices and develop the foundation to address other priorities including comparative performance of systems and providers, and development of performance-improvement incentives. These findings will be especially important to AHRQ priority populations, including low-income, minority, rural, and people with chronic illnesses.