Measuring the Structure and Process of Pediatric Trauma Care

描述（由申请人提供）：创伤性脑损伤（TBI）是儿童和青少年创伤死亡的最常见原因，也是获得性残疾的最常见原因之一。康复被认为是在严重创伤，特别是严重脑外伤后实现最佳恢复的关键。然而，在确定如何组织康复护理以及不同的护理过程如何与功能结果相关方面，特别是在儿童和青少年中，进展有限。一个关键的障碍是缺乏对护理的组织和过程的标准化衡量，以及对受伤患者住院康复护理的有效衡量标准的有限可用性。在本应用中，我们将识别和测量儿科TBI患者住院康复设施的护理结构和流程，并检查这些维度在康复设施和儿科TBI患者之间的差异。我们将(1)开发一个系统来衡量儿科TBI患者在住院康复期间接受的护理结构和过程。这将通过对文献的系统回顾和专家小组的德尔菲过程来完成。(2)评估和测试一种数据收集工具，该工具可用于收集有关儿科住院康复护理的结构/组织和流程的信息。(3)使用这些工具来检查美国儿童TBI患者康复设施的结构/组织和康复护理过程中的变化。本研究的长期目标是为受伤儿童提供最佳护理，使他们在严重创伤后能够获得最好的治疗结果。这个提议的项目是减少护理变化的重要步骤，并确定哪种护理结果最佳。公共卫生相关性：本研究的长期目标是为受伤儿童提供最佳护理，使他们在严重创伤后能够获得最好的结果。这个提议的项目是减少护理变化的重要步骤，并确定哪种护理结果最佳。

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.