Measuring the Structure and Process of Pediatric Trauma Care

描述(申请人提供)：创伤性脑损伤(TBI)是儿童和青少年因创伤死亡的最常见原因，也是后天残疾最常见的原因之一。康复一直被认为是严重创伤，特别是严重脑外伤后实现最佳康复的关键。然而，在确定康复护理的组织和不同护理过程如何与功能结果相关方面取得的进展有限，特别是在儿童和青少年中。一个关键障碍是缺乏对护理组织和过程的标准化衡量，以及在住院受伤患者康复过程中有效的护理衡量标准有限。在这项应用中，我们将确定和衡量住院脑损伤患者康复机构的护理结构和流程，并检查康复机构和儿科脑损伤患者在这些维度上的变异性。我们将(1)开发一个衡量儿童脑外伤患者在住院康复期间接受护理的结构和过程的系统。这将通过对文献的系统审查和专家小组的德尔菲过程来完成。(2)评估和测试数据收集工具，该工具可用于收集有关儿科住院康复护理的结构/组织和过程的信息。(3)使用这些仪器检查美国各地脑外伤患者康复设施的结构/组织以及康复护理过程中的变化。这项研究的长期目标是为受伤的儿童提供最佳的护理，使他们在严重创伤后能够获得尽可能好的结果。这一拟议的项目是减少护理差异和确定哪些护理产生最佳结果的关键一步。公共卫生相关性：这项研究的长期目标是为受伤儿童提供最佳护理，使他们能够在严重创伤后获得尽可能好的结果。这一拟议的项目是减少护理差异和确定哪些护理产生最佳结果的关键一步。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is the most common cause of death from trauma in children and adolescents and one of the most common causes of acquired disability. Rehabilitation has been viewed as critical to achieving optimal recovery after serious trauma, especially serious TBI. However, there has been limited progress on determining how the organization of rehabilitation care and how the different processes of care are related to functional outcome, especially in children and adolescents. A critical barrier has been the lack of standardized measurement of the organization and processes of care and limited availability of valid measurement criteria for care in the inpatient rehabilitation of injured patients. In this application, we will identify and measure the structure and processes of care in inpatient rehabilitation facilities for pediatric patients with TBI, and examine the variability in these dimensions across rehabilitation facilities and pediatric TBI patients. We will (1) develop a system for measuring the structure and processes of care received by pediatric TBI patients during inpatient rehabilitation. This will be done through a systematic review of the literature and a Delphi process with an expert panel. (2) Evaluate and test a data collection instrument that can be used to collect information on the structure/ organization and processes of care for pediatric inpatient rehabilitation. (3) Use these instruments to examine variations in the structure/ organization of rehabilitation facilities and in the processes of rehabilitation care for pediatric patients with TBI across the US. The long term goal of this study is to deliver optimal care to injured children so that they can attain the best possible outcomes after serious trauma. This proposed project is an essential step in reducing variations in care, and determining which care results in optimal outcomes. Public Health Relevance: The long term goal of this study is to deliver optimal care to injured children so that they can attain the best possible outcomes after serious trauma. This proposed project is an essential step in reducing variations in care, and determining which care results in optimal outcomes.