Improving Syncope Risk Stratification in Older Adults

改善老年人晕厥风险分层

基本信息

批准号：
8435281
负责人：
Benjamin C Sun
金额：
$ 81.5万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-02-01 至 2018-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8435281
关键词：
Accident and Emergency department Accounting Address Admission activity Age Algorithms Biological Markers Cardiac Cardiac Death Caring Cause of Death Cessation of life Characteristics Clinical Contractor Data Decision Making Diagnostic Diagnostic tests Elderly Electrocardiogram Enrollment Evaluation Event Expenditure Goals Health Care Costs Health Services Hospital Costs Hospitalization Hospitals Incidence Inpatients Lead Medicare Methods Modeling Observational Study Outcome Patient Admission Patients Pattern Patterns of Care Physicians Publishing Quality of life Recovery Research Retrospective Studies Risk Risk Assessment Statistical Methods Stratification Syncope Syndrome Testing Therapeutic Uncertainty Unconscious State United States Validation Visit Work base cost evidence base high risk improved innovation mortality novel older patient pressure prospective public health relevance tool

项目摘要

DESCRIPTION (provided by applicant): There are 740,000 annual events of syncope (transient loss of consciousness) that lead to an emergency department (ED) visit, resulting in 250,000 admissions and $2.4 billion in yearly hospital costs. There are currently no effective prediction tools to identify older patients (agee60 years) who may be at risk for subsequent cardiac death or serious cardiac events. As a result, up to 85% of older adults with syncope are hospitalized for diagnostic evaluation. However, there is no evidence that admission improves diagnostic yield, quality-of-life, or mortality. Fundamental problems with the existing paradigm of care include inaccurate risk assessment and the lack of an evidence base to match predicted risk with appropriate clinical actions. Furthermore, existing research is virtually silent on how t risk stratify and evaluate older adults, who disproportionately account for diagnostic uncertainty, health service use, and serious outcomes. As a result, practice patterns have not changed over the past 30 years. Mounting pressures to constrain health care costs increase the topicality of this problem, and syncope was recently identified as one of the top conditions targeted by Medicare Recovery Audit Contractors for repossession of medically unnecessary inpatient expenditures. Innovative care models must be developed to improve the efficiency and value of the ED evaluation. To address these needs, we propose a prospective, observational study of 3,700 older adults with unexplained syncope enrolled from four emergency departments. Our specific hypotheses are that: 1.) current patterns of care are costly with low clinical benefit; 2. explicit criteria will improve risk stratification compared to unstructured physician assessment and published risk models; and 3.) risk-based decision-making can safely reduce costs compared to existing care. To assess these hypotheses, our proposal has the following sequential Aims: Specific Aim 1. Describe rates, diagnostic yield, therapeutic yield, and costs of diagnostic admission and testing associated with existing care. Specific Aim 2. Derive and validate a novel risk prediction model for 30-day cardiac death and serious cardiac outcomes after unexplained syncope. Specific Aim 3. Estimate diagnostic yield and costs of implementing risk-based decision algorithms. Our study will result in innovative care algorithms for a common and costly syndrome, and completion of our Aims will facilitate a paradigm shift in the evaluation of syncope in older adults.

描述（由申请人提供）：有740,000个年度晕厥（暂时性丧失意识丧失），导致急诊科（ED）访问，导致25万名入院和24亿美元的年度医院费用。目前尚无有效的预测工具来识别老年患者（年龄60岁），他们可能有后续心脏死亡或严重心脏事件的风险。结果，多达85％的晕厥老年人住院以进行诊断评估。但是，没有证据表明入院可提高诊断产量，生活质量或死亡率。现有范式的基本问题护理包括不准确的风险评估以及缺乏证据基础，无法将预测的风险与适当的临床行动相匹配。此外，现有的研究几乎对T风险如何分层和评估老年人保持沉默，他们不成比例地说明了诊断不确定性，健康服务的使用和严重的结果。结果，在过去30年中，练习模式没有改变。限制医疗保健成本的安装压力增加了此问题的主题，而晕厥最近被确定为Medicare Recovery Recution Audit Contrestors针对的最佳条件之一，以收回医学上不必要的住院费用。必须开发创新的护理模型，以提高ED评估的效率和价值。为了满足这些需求，我们提出了一项对来自四个急诊室招收的3700名老年人的前瞻性观察性研究。我们的具体假设是：1。）当前的护理模式成本高昂，临床益处较低； 2。与非结构化的医师评估和已发布的风险模型相比，明确的标准将改善风险分层； 3.）与现有护理相比，基于风险的决策可以安全降低成本。为了评估这些假设，我们的建议具有以下顺序目标：特定目的1。描述率，诊断产量，治疗产量以及与现有护理相关的诊断入院和测试的成本。具体目标2。在无法解释的晕厥后，为30天心脏死亡和严重的心脏结局提供了新的风险预测模型。特定目的3。估计诊断产量和实施基于风险的决策算法的成本。我们的研究将导致常见且昂贵的综合症的创新护理算法，并且我们的目标的完成将有助于老年人评估晕厥的评估范式转移。