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）：危重疾病是每年影响数百万美国人的重大公共卫生问题，并与相当大的发病率和死亡率相关。其中许多死亡可能是可以预防的，ICU 内风险调整死亡率的巨大差异以及临床证据与实践之间持续存在的差距就证明了这一点。因此，需要制定全系统策略来改善 ICU 的治疗效果并加快证据转化为实践。公开报告医疗保健结果措施就是这样的策略之一。从理论上讲，公共报告的作用是为消费者提供选择高质量医疗保健提供者所需的信息，并激励医生和医疗保健系统在质量上进行竞争。尽管公共报告计划正在扩大，但有限的证据表明这些计划可以改善医疗保健结果，同时还担心它们可能会造成意想不到的负面后果，包括医疗保健提供者避免接触患病患者，因为这些患者可能会对提供者公开报告的医疗保健绩效指标产生负面影响。考虑到与公开报告相关的潜在好处和风险，在大规模实施之前有必要更好地了解其对 ICU 的影响。该提案将利用一项自然实验来解决这些知识差距，在该实验中，加利福尼亚州自 2007 年以来一直公开报告 ICU 院内死亡率，而其他州则没有。该提案的总体目标是通过将加州 ICU 病例组合和结果的变化与实施公开报告前后美国其他地区的变化进行比较，确定 ICU 公开报告的效果。首先，我们将确定 ICU 公开报告对 ICU 入住患者选择的影响，检查加州入住 ICU 的患者类型与其他地区相比是否存在差异。其次，我们将确定 ICU 公开报告对风险调整后 ICU 结果的影响，检查加州的院内死亡率、30 天死亡率和急性后护理利用情况与其他地区相比是否存在差异。我们的项目将使用来自医疗保险提供者分析和审查 (MedPAR) 文件的国家患者级数据、最先进的贝叶斯统计模型以及“双重差异”方法来帮助控制病例变异-跨地区的混合和时间趋势。总的来说，我们的结果将提供重要的知识，可用于指导有关 ICU 系统范围绩效改进举措的临床决策和医疗保健政策。此外，该项目将为申请人提供扩展其在重症监护结果和高级统计模型领域的研究技能的机会。通过申请人的培训计划（包括基于项目的学习、指导、课程作业和会议），申请人将获得结果研究、生物统计学和医疗保健政策方面的培训。该培训计划旨在确保候选人成功发展为独立研究员。