Effects of publicly reporting intensive care unit outcomes

公开报告重症监护病房结果的影响

• 批准号: 8524278
• 负责人: Lora Ann Reineck
• 金额: $ 6.65万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8524278
• 关键词: Acute; Acute Lung Injury; Address; Admission activity; Affect; Age; American; Area; Benefits and Risks; Biometry; California; Cardiac Surgery procedures; Caring; Case Mixes; Cessation of life; Clinical; Country; Critical Care; Critical Illness; Data; Development; Discipline of obstetrics; Future; Goals; Health Personnel; Health Policy; Healthcare; Healthcare Systems; Hospital Mortality; Hospitals; Intensive Care; Intensive Care Units; K-Series Research Career Programs; Knowledge; Lead; Learning; Length of Stay; Measurement; Measures; Medicare; Mentors; Morbidity - disease rate; Natural experiment; Nature; Outcome; Outcome Measure; Outcomes Research; Patient Selection; Patients; Performance; Physicians; Policy Maker; Provider; Public Health; Reporting; Research; Research Personnel; Risk; Sepsis; Speed; Statistical Models; Syndrome; System; Time; Training; Translations; United States; Variant; Work; base; clinical decision-making; comorbidity; design; effectiveness research; evidence base; high risk; improved; insight; mortality; premature; programs; public health relevance; skills; symposium; theories; trend

DESCRIPTION (provided by applicant): Critical illness is a significant public health problem affecting millions of Americans each year and associated with considerable morbidity and mortality. Many of these deaths are likely preventable, as evidenced by considerable variation in risk-adjusted mortality across ICUs and persistent gaps between clinical evidence and practice. Therefore, system-wide strategies to improve ICU outcomes and speed translation of evidence into practice are needed. Public reporting of healthcare outcome measures is one such strategy. In theory, public reporting works by providing consumers with the necessary information to select high-quality healthcare providers and by motivating physicians and healthcare systems to compete on quality. Although public reporting programs are expanding, there is limited evidence that these programs improve healthcare outcomes along with concerns that they may cause unintended negative consequences including the avoidance of sick patients by healthcare providers since these patients may negatively impact provider's publicly reported healthcare performance measures. Given the potential benefits and risks associated with public reporting, it is essential to better understand its impact in the ICU prior to implementing it on large scale. This proposal will address these knowledge gaps by taking advantage of a natural experiment in which California has been publicly reporting ICU in-hospital mortality rates since 2007, while other states have not. The overall goal of this proposal is to determine the effect of public reporting in the ICU by comparing changes in ICU case-mix and outcomes in California to changes in other parts of the country before and after the implementation of public reporting. First, we will determine the effect of ICU public reporting on selection of patients for ICU admission, examining whether the type of patients admitted to ICUs changed differentially in California compared to other regions. Second, we will determine the effect of ICU public reporting on risk-adjusted ICU outcomes, examining whether in-hospital mortality, 30-day mortality, and post-acute care utilization changed differentially in California compared to other regions. Our project will use national, patient-level data from the Medicare Provider Analysis and Review (MedPAR) files, state-of-the-art Bayesian statistical models, and a "difference-in-differences" approach to help control for variation in case-mix and temporal trends across regions. Overall our results will provide important knowledge that can be used to guide clinical decision making and healthcare policy regarding system-wide performance improvement initiatives in the ICU. Additionally, this project will provide the applicant the opportunity to expand her research skills in the area of critical care outcomes and advanced statistical modeling. Through the applicant's training plan which includes project- based learning, mentoring, coursework, and conferences, the candidate will acquire training in outcomes research, biostatistics, and healthcare policy. This training plan has been designed to assure the candidate's successful development to an independent researcher.

描述（由申请人提供）：重症疾病是每年影响数百万美国人的重大公共卫生问题，并且与大量发病率和死亡率有关。这些死亡中的许多死亡可能是可以预防的，这是通过ICU的风险调整死亡率发生很大差异以及临床证据与实践之间的持续差距所证明的。因此，需要采取全系统范围的策略来改善ICU结果并将证据转化为实践。医疗保健结果指标的公开报告就是这样的策略。从理论上讲，公开报告的工作是通过为消费者提供必要的信息来选择高质量的医疗保健提供者，并激励医生和医疗保健系统以竞争质量。尽管公开报告计划正在扩大，但有限的证据表明，这些计划改善了医疗保健结果，并担心它们可能会造成意外的负面后果，包括医疗保健提供者避免患病患者，因为这些患者可能会对提供者的公开报告的医疗保健绩效指标产生负面影响。鉴于与公开报告相关的潜在利益和风险，必须在大规模实施之前更好地了解其在ICU中的影响。该提案将通过利用自然实验来解决这些知识差距，在该实验中，加利福尼亚自2007年以来一直在公开报告ICU内房屋死亡率，而其他州则没有。该提案的总体目标是通过比较ICU病例混合和加利福尼亚州的结果与实施公开报告之前和之后的变化来确定ICU中公开报告的影响。首先，我们将确定ICU公开报告对ICU入院患者选择的影响，以检查与其他地区相比，加利福尼亚州ICU的患者的类型是否有所不同。其次，我们将确定ICU公开报告对风险调整后的ICU结果的影响，研究与其他地区相比，加利福尼亚州的院内死亡率，30天死亡率和急性后护理利用率是否有所不同。我们的项目将使用Medicare提供者分析和审查（MEDPAR）文件，最先进的贝叶斯统计模型以及“差异差异”方法的国家，患者级数据来帮助控制案例混合和各个地区的时间趋势的变化。总体而言，我们的结果将提供重要的知识，可用于指导有关ICU中系统范围内绩效计划的临床决策制定和医疗保健政策。此外，该项目将为申请人提供机会在重症监护效果和高级统计建模领域扩大她的研究技能。通过申请人的培训计划，包括基于项目的学习，指导，课程和会议，候选人将获得成果研究，生物统计学和医疗保健政策的培训。该培训计划旨在确保候选人对独立研究人员的成功发展。