Understanding Variation in Failure to Rescue in the Eldery

了解老年人抢救失败的差异

• 批准号: 8435892
• 负责人: John D Birkmeyer
• 金额: $ 32.93万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8435892
• 关键词: American; Area; Attitude; Behavior; Blood Vessels; Caregivers; Caring; Case Fatality Rates; Cessation of life; Climate; Clinical; Communication; Complication; Critical Illness; Educational process of instructing; Elderly; Failure; Goals; Hospital Sizes; Hospital safety; Hospitals; Incentives; Inpatients; Intensive Care Units; Intervention; Joint Commission on Accreditation of Healthcare Organizations; Joints; Link; Michigan; Morale; Nursing Staff; Operative Surgical Procedures; Patients; Physicians; Physiological; Population; Postoperative Care; Procedures; Questionnaires; Research; Resources; Risk; Safety; Structure; Surgical complication; Surveys; System; Time; Training; United States; United States Centers for Medicare and Medicaid Services; Variant; behavior influence; high risk; improved; insight; microsystems; mortality; older patient; population based; programs; response; American; Area; Attitude; Behavior; Blood Vessels; Caregivers; Caring; Case Fatality Rates; Cessation of life; Climate; Clinical; Communication; Complication; Critical Illness; Educational process of instructing; Elderly; Failure; Goals; Hospital Sizes; Hospital safety; Hospitals; Incentives; Inpatients; Intensive Care Units; Intervention; Joint Commission on Accreditation of Healthcare Organizations; Joints; Link; Michigan; Morale; Nursing Staff; Operative Surgical Procedures; Patients; Physicians; Physiological; Population; Postoperative Care; Procedures; Questionnaires; Research; Resources; Risk; Safety; Structure; Surgical complication; Surveys; System; Time; Training; United States; United States Centers for Medicare and Medicaid Services; Variant; behavior influence; high risk; improved; insight; microsystems; mortality; older patient; population based; programs; response

DESCRIPTION (provided by applicant): Elderly patients comprise a large majority of the 100,000 Americans who die every year undergoing inpatient surgery. Wide variation in mortality rates across hospitals suggests substantial opportunities for improvement. Recent research suggests that such variation is determined primarily by how successfully hospitals recognize and manage complications once they occur. Thus, minimizing "failure to rescue" (i.e., death following a major complication) may be essential in efforts to reduce surgical mortality. Unfortunately, previous research does not provide actionable insights into how hospitals can improve in this regard. A better understanding of hospital structure at the micro-system level, including details related to ICU staffing, physician coverage, and rapid response teams, is essential. Other organizational attributes-including staff morale, teamwork, communication, and attitudes toward safety-could be even more crucial in minimizing failure to rescue. To explore these issues, we propose a multi-center study involving 34 hospitals participating in the Michigan Surgical Quality Collaborative (MSQC), the largest population-based collaborative quality improvement program in the United States. We will first assess the presence of micro-system resources potentially related to FTR, including aspects of staffing and organization, the structure and function of rapid response teams, and training and quality improvement programs. In our second specific aim, we will evaluate safety attitudes and culture using the Safety and Teamwork Climate Survey and their associations with hospital-specific FTR rates, targeting clinical leaders and caregivers of the major units involved in the care of postoperative patients. Finally, we will assess safety-related practices and behaviors, using the Safety Organizing Scale. We hypothesize that hospitals with high FTR rates will have fewer resources and score worse with regards to safety climate, teamwork and communication. This project will have direct, population-level impact as our findings inform interventions aimed at reducing mortality in surgical patients in Michigan, and ultimately elsewhere. Results from this study will also inform large payers (including CMS) and regulators (particularly JCAHO) as they set incentives and standards for enhancing the safety of inpatient surgery in the United States. PUBLIC HEALTH RELEVANCE: The elderly have markedly higher mortality after inpatient surgery not because they have more complications, but because they are 3 times more likely to die once a complication has occurred. This study will examine hospital resources, safety attitudes and behaviors underlying so-called failure to rescue after surgical complications at 34 Michigan hospitals. This project will have direct, population-level impact as our findings inform interventions aimed at reducing surgical mortality in the elderly in Michigan, and ultimately elsewhere.

描述（由申请人提供）：老年患者每年在接受住院手术的100,000名美国人中，大多数人中有很多。整个医院死亡率的广泛差异表明改善机会。最近的研究表明，这种差异主要取决于医院一旦发生的并发症的成功识别和管理并发症。因此，最大程度地减少“未能营救”（即重大并发症后的死亡）对于降低手术死亡率的努力至关重要。不幸的是，以前的研究并未提供有关医院在这方面如何改善的可行见解。对微型系统层面的医院结构有更好的了解，包括与ICU人员配备，医师覆盖范围和快速反应团队有关的细节至关重要。其他组织属性 - 包括员工的士气，团队合作，沟通和对安全态度的态度对于最大程度地减少未能营救的态度至关重要。为了探索这些问题，我们提出了一项多中心研究，涉及34家参加密歇根州外科手术质量协作（MSQC）的医院，这是美国最大的基于人群的协作质量改进计划。我们将首先评估可能与FTR相关的微型系统资源的存在，包括人员配备和组织的各个方面，快速响应团队的结构和功能以及培训和质量改进计划。在我们的第二个特定目标中，我们将使用安全和团队合作的气候调查及其与医院特异性的FTR率的关联来评估安全态度和文化，以针对涉及术后患者护理的主要单位的临床领导者和护理人员。最后，我们将使用安全组织量表来评估与安全相关的实践和行为。我们假设FTR率较高的医院的资源将较少，并且在安全环境，团队合作和沟通方面得分较差。该项目将具有直接的人口层面影响 密歇根州和其他地方的手术患者。这项研究的结果还将告知大型付款人（包括CMS）和监管机构（尤其是JCAHO），因为它们设定了激励措施和标准，以提高美国住院手术的安全性。 公共卫生相关性：住院手术后，老年人的死亡率明显更高，不是因为他们的并发症更多，而是因为一旦发生并发症发生，他们死亡的可能性要高3倍。这项研究将检查医院的资源，安全态度和行为，即在34家密歇根州医院的手术并发症后，所谓的未能营救。该项目将具有直接的人口级影响，因为我们的发现为旨在降低密歇根州老年人的手术死亡率以及最终在其他地方的干预提供了干预措施。