Reducing Ethnic-racial Disparities in Cardiac Arrest Survival Outcomes (RED-CASO)

减少心脏骤停生存结果的种族差异 (RED-CASO)

基本信息

批准号：
10338932
负责人：
Paul Sheung-Yan Chan
金额：
$ 67万
依托单位：
SAINT LUKE'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10338932
关键词：
911 call Accident and Emergency department Address Administrator Adopted Adoption Affect American Heart Association Baseline Surveys Black Populations Black race Blood Circulation Cardiology Cardiopulmonary Resuscitation Caring Cause of Death Censuses Centers for Disease Control and Prevention (U.S.)Communities Community Services Data Effectiveness Emergency Medicine Emergency medical service Ensure Epidemiology Ethnic Origin Face Fire - disasters Focus Groups Foundations Future Goals Heart Arrest Hispanic Hispanic Populations Hospitals Immigration Individual Interview Knowledge Language Life Low income Medical Staff Methodology Methods Mission Morbidity - disease rate National Heart, Lung, and Blood Institute Native Americans Neighborhoods Outcome Outcome Study Paramedical Personnel Patient-Focused Outcomes Patients Peer Review Persons Police Policies Practice Guidelines Pre-hospital setting Pre-hospitalization care Process Public Health Publications Registries Research Research Methodology Research Personnel Resources Resuscitation Risk Sampling Site Site Visit Surveys Survival Rate System Time Universities Variant Work care systems community engagement cost design disparity reduction emergency settings first responder health equity health equity promotion hispanic community improved improved outcome innovation insight mortality multidisciplinary novel out-of-hospital cardiac arrest premature racial and ethnic disparities response routine practice survival outcome

项目摘要

PROJECT SUMMARY / ABSTRACT The public health burden of out-of-hospital cardiac arrest (OHCA) is enormous, affecting ~350,000 individuals each year in the U.S. and is the third leading cause of death. To improve our understanding of OHCA, the Cardiac Arrest Registry to Enhance Survival (CARES) was launched by Emory University and the Centers for Disease Control and Prevention. Through >70 peer-reviewed publications over the past 2 decades, CARES has transformed our understanding of the epidemiology and outcomes of patients with OHCA. Yet, little is known as to how some emergency medical service (EMS) agencies achieve higher survival rates for their patients with OHCA than other agencies. While variation in OHCA survival is largely believed to be due to adoption of key care processes by EMS agencies in the prehospital setting, how these processes are employed in routine practice, the underlying factors contributing to their successful implementation, and effective interactions between EMS agencies with the community, first responders (e.g., police, fire), 911 dispatchers, and hospitals have not been systematically defined. Moreover, despite the fact that Black and Hispanic patients have lower survival rates for OHCA than White patients, there is scant research on how to reduce disparities in OHCA survival and how top-performing EMS agencies that work in majority Black or Hispanic communities overcome additional barriers to prehospital OHCA response and care. Accordingly, we propose the RED-CASO (Reducing Ethnic-racial Disparities in Cardiac Arrest Survival Outcomes) study to address these critical gaps in knowledge and to lay the foundation for quality improvement efforts to reduce disparities in OHCA survival. First, we will identify top-performing and bottom-performing EMS agencies in OHCA survival, with a focus on those that work in majority Black or Hispanic communities. Second, we will identify ‘best practices’ at top-performing EMS agencies in OHCA survival through detailed interviews with key stakeholders during site visits. We will intentionally sample EMS agencies which work in majority Black or Hispanic communities, and these agencies will comprise at least half of the sites visited. And third, we will validate these best practices associated with EMS agencies with the highest survival rates for OHCA. We will use a sequential mixed-methods approach with a focus on identifying best practices at top- performing EMS agencies which work in communities where most residents are Black or Hispanic. We will build on work by our investigative team to systematically understand factors associated with survival for other emergency settings (in-hospital cardiac arrest) and leverage our team’s multidisciplinary expertise in cardiology, emergency medicine, epidemiology, and mixed methods research. Findings from this study will be used to construct a ‘best practices guide’ for OHCA that can be implemented by EMS agencies both within CARES and with national partners such as the American Heart Association to improve OHCA survival in predominantly non-White communities and, in turn, reduce racial and ethnic disparities in OHCA outcomes.

项目概要/摘要院外心脏骤停 (OHCA) 给公众健康带来巨大负担，影响约 350,000 人每年在美国，它是第三大死亡原因。心脏骤停登记处以提高生存率 (CARES) 由埃默里大学和心脏骤停中心发起疾病控制与预防。过去 20 年来，CARES 发表了超过 70 篇经过同行评审的出版物。改变了我们对 OHCA 患者流行病学和结果的理解，但变化甚微。一些紧急医疗服务 (EMS) 机构如何实现更高的生存率 OHCA 患者的生存率高于其他机构，而 OHCA 生存率的差异很大程度上被认为是由于 EMS 机构在院前环境中采用关键护理流程，这些流程是如何进行的在日常实践中采用的、有助于其成功实施的根本因素，以及 EMS 机构与社区、急救人员（例如警察、消防）、911 之间的有效互动此外，尽管布莱克和医院尚未得到系统的定义。西班牙裔患者的 OHCA 存活率低于白人患者，关于如何治疗的研究很少减少 OHCA 生存方面的差异，以及在大多数黑人或黑人中工作的表现最好的 EMS 机构如何西班牙裔社区克服了院前 OHCA 应对和护理的额外障碍。因此，我们提出 RED-CASO（减少心脏骤停生存中的种族差异）结果）研究，以解决这些关键知识差距并为质量改进奠定基础为了减少 OHCA 生存率的差异，我们将确定表现最好和表现最差的 EMS。 OHCA 生存机构，重点关注那些在大多数黑人或西班牙裔社区工作的机构。其次，我们将通过详细的研究，确定表现最好的 EMS 机构在 OHCA 生存方面的“最佳实践” 我们将在实地考察期间对主要利益相关者进行访谈，并有意对在该地区工作的 EMS 机构进行抽样调查。大多数黑人或西班牙裔社区，这些机构将至少占访问地点的一半。第三，我们将验证这些与生存率最高的 EMS 机构相关的最佳实践 OHCA。我们将使用顺序混合方法，重点是确定顶层的最佳实践。我们将在大多数居民是黑人或西班牙裔的社区中执行 EMS 机构。以我们的调查团队的工作为基础，系统地了解与他人生存相关的因素紧急情况（院内心脏骤停）并利用我们团队的多学科专业知识这项研究的结果将包括心脏病学、急诊医学、流行病学和混合方法研究。用于构建 OHCA 的“最佳实践指南”，可由 EMS 机构实施 CARES 并与美国心脏协会等国家合作伙伴一起提高 OHCA 的生存率主要是非白人社区，进而减少 OHCA 结果中的种族和民族差异。