Effect of Paramedic Airway Experience on Patient Outcomes

描述(由申请人提供)：这是为NHLBI R21创新研究资助计划提出的建议，该计划鼓励对现有数据集的分析，以探索新的假设。气管内插管(ETI)是将塑料管插入气管(喉咙)，帮助患有心肺骤停、心力衰竭、呼吸衰竭或严重创伤等危重疾病的患者呼吸。虽然ETI是由医院的医生进行的，但复苏通常是在院外环境下由护理人员护理开始的。在临床实践的许多领域，医疗差错被认为与从业者的程序量以及患者的预后有关。许多研究发现，护理人员在进行ETI时会出错。此外，在一项初步研究中，我们发现护理人员在临床实践中很少进行ETI，而且频率远远低于维持程序熟练程度、安全性和有效性所需的频率。程序、成功和错误与患者结果(包括医院病程或资源利用)之间几乎没有直接联系。我们推测，由缺乏操作经验的护理人员进行ETI可能会对患者的预后和医院的护理过程产生不利影响。这项研究的目的是确定护理人员(ETI)的程序经验是否与患者的结局和住院护理过程有关。在拟议的研究中，我们将以概率方式连接三个可公开获得的全州行政数据库，包括辅助医疗患者遭遇、住院患者和死亡。我们将对关联数据集应用多变量回归来评估辅助医疗ETI程序经验(ETI年量)、结果(死亡率和医院内不良事件)和医院资源利用之间的关系。我们建议匹兹堡大学和犹他州大学的研究团队之间进行新的合作，这两个研究团队在医院外护理、医疗服务研究、大规模数据集分析和概率联系方面拥有专业知识。这些发现可能表明，护理人员的ETI经验直接影响患者的预后，并可能促进这种挽救生命的院外干预措施的设计和实施方面的重大变化。这些发现还将证实，这种关联方法是一种新的、强大的工具，可以评估急性医疗护理的最早部分--开始于医院外环境。

DESCRIPTION (provided by applicant): This is a proposal for the NHLBI R21 Innovative Research Grant Program, which encourages the analysis of existing data sets to explore new hypotheses. Endotracheal intubation (ETI) is the insertion of a plastic tube into the trachea (throat) to assist the breathing of a patient with a critical illness such as cardiopulmonary arrest, heart failure, respiratory failure or major trauma. While ETI is performed by physicians in the hospital, resuscitation usually begins in the out-of- hospital setting under the care of paramedics. In many fields of clinical practice, medical errors are known to be associated with both practitioner procedural volume as well as patient outcome. Many studies have found that paramedics commit errors when performing ETI. Furthermore in a preliminary study, we found that paramedics perform ETI infrequently in clinical practice and at frequencies far below that needed to maintain procedural proficiency, safety and effectiveness. Few direct links between the procedure, success and errors, and patients outcomes (including hospital course or resource utilization) exist. We posit that ETI performed by paramedics with low procedural experience may adversely affect patient outcome and hospital course of care. The goal of this study is to determine if paramedic (ETI) procedural experience is associated with patient outcomes and in-hospital course of care. In the proposed study we will probabilistically link three publicly- available statewide administrative databases encompassing paramedic patient encounters, admitted inpatients and deaths. We will apply multivariable regression to the linked data set to evaluate the connection between paramedic ETI procedural experience (annual volume of ETI), outcomes (mortality and in-hospital adverse events) and in-hospital resource utilization. We propose a new collaboration between research teams at the Universities of Pittsburgh and Utah, which have expertise in the areas of out-of-hospital care, health services research, the analysis of large-scale data sets and probabilistic linkage. These findings may demonstrate that paramedic ETI experience directly impacts patient outcome, and may promote major changes in the design and delivery of this life-saving out- of-hospital intervention. These findings would also confirm this linkage method as a new, powerful tool to evaluate the earliest portion of acute medical care - that begun in the out-of-hospital setting.