Emergency Care Sensitive Conditions in the VA

退伍军人管理局的紧急护理敏感情况

• 批准号: 8865045
• 负责人: Anita A Vashi
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8865045
• 关键词: 18 year old; Accident and Emergency department; Acute; Address; Admission activity; Advocate; Ambulatory Care; California; Caring; Cessation of life; Characteristics; Chronic Disease; Communities; Country; Data; Data Quality; Data Set; Databases; Development; Diagnosis; Early Intervention; Emergency Care; Emergency Situation; Emergency department visit; Enrollment; Ensure; Equipment and supply inventories; Event; Fee-for-Service Plans; Fees; Fostering; Future; Health Policy; Healthcare; Healthcare Systems; Heart Arrest; Hospital Mortality; Hospitals; Individual; Inpatients; Institutional Review Boards; Intervention; Investigator-Initiated Research; Lead; Link; Measurement; Measures; Medicare; Methods; Modeling; Outcome; Outcome Measure; Outpatients; Output; Patients; Pharmaceutical Services; Policies; Policy Developments; Prevalence; Process; Protocols documentation; Provider; Publishing; Quality of Care; Recruitment Activity; Research Design; Research Proposals; Services; Staging; Stroke; Structure; Surveys; Survival Rate; System; Time; To specify; Triage; Variant; Veterans; Visit; Woman; base; care systems; cohort; cost; design; improved; indexing; knowledge base; member; men; natural hypothermia; novel; novel strategies; rapid diagnosis; research study; safety net; statistics

 DESCRIPTION (provided by applicant). Background. Emergency care is a critical, but understudied, part of the continuum of services offered to Veterans by the VA. While the VA is committed to providing timely and high-quality emergency care, surprisingly little is known about Veteran access to acute care or about the quality of care provided. Using a model derived from the development and widespread use of ambulatory care sensitive conditions (ACSCs) we propose using the emergency care sensitive condition (ECSC), a newly defined concept, as a novel framework to examine variation in access to and quality of emergency care systems. Analogous to ACSCs, ECSCs are conditions for which early access to high-quality emergency diagnosis and intervention in acute illness or acutely decompensated chronic illness improves patient outcomes. Objectives. This pilot lays the groundwork for two subsequent Investigator Initiated Research proposals that will examine access to emergency care and the individual, organizational and system factors related to ECSC outcomes, such as survival rates and 30 day post-discharge events. Our specific objectives for this pilot are. (1) to create a VA Emergency Department (ED) visit level dataset that can be used as part of a future study of Veteran utilization of emergency care across VHA and non-VHA settings; (2) to calculate the prevalence and determine variation, if any, of ECSCs across all VHA EDs; and (3) to refine the recently defined list of ECSCs and identify the ECSCs of most import to Veterans. Project Methods. First, using VA administrative files, we will construct a database that includes women and men Veterans aged 18 years and over who had any VA care, including outpatient, inpatient, non-VA care (Fee) services, or pharmacy services identified in the ADUSH Enrollment File FY10-FY12. All ED visits among the cohort will be identified. ED visits will be specified to be either an (1) ED visit resulting in discharge [ED tret-and-release visit], (2) ED visit resulting in hospital admission, (3) ED visit resulting in patient death, (4) an ED observation stay or (5) fee basis non-VA ED visit. The database will be structured to reflect the anticipated three-level analysis structure (i.e., visits are clustered by patients, which in turn, are clustered within stations). Next, using descriptive statistics, we wil calculate prevalence and determine variation, if any, of ECSCs across all VHA EDs. Finally, using a modified Delphi approach, we will refine the list of ECSCs of import to Veterans. These data will us to design and conduct a national study of the Veteran-, ED-, system-, and geographic-level predictors of access to high quality ED care.

 描述（由应用程序提供）。 背景。急诊护理是弗吉尼亚州向退伍军人提供的持续服务的一部分至关重要的部分。虽然VA致力于提供及时，高质量的急诊护理，但对于退伍军人获得急诊护理或提供的护理质量的知之甚少。使用源自卧床护理敏感条件（ACSC）的开发和宽度使用的模型，我们建议使用紧急护理敏感条件（ECSC），这是一种新定义的概念，作为一个新的框架，以研究急诊系统访问和质量的变化。 ECSC类似于ACSC，是早期获得高质量紧急诊断和急性疾病干预或急性代偿性慢性疾病的疾病，可改善患者的结局。目标。该飞行员为两名随后的研究者奠定了基础，该提案将检查急诊室的访问以及与ECSC结果有关的个人，组织和系统因素，例如生存率和入院后30天。我们对该飞行员的具体目标是。 （1）创建一个VA急诊室（ED）访问级别数据集，该数据集可以用作未来对VHA和非VHA环境中急诊疗法的资深急诊研究的一部分； （2）计算所有VHA EDS的ECSC的患病率和确定的差异； （3）要完善最近定义的ECSC列表，并确定向退伍军人进口的ECSC。项目方法。首先，使用VA管理文件，我们将构建一个数据库，其中包括18岁及以上的男女退伍军人，其中包括任何VA护理，包括门诊，住院，非VA护理（费用）服务或在Adush招募文件中确定的Pharmacy Services，或者在Adush招募文件中确定的药物服务。将确定该队列中的所有ED访问。 ED访问将被指定为（1）ED访问，导致出院[ED TRET和释放访问]，（2）ED访问，导致住院，（3）ED访问导致患者 死亡，（4）ED观察逗留或（5）收费基础非访问。该数据库将结构结构以反映预期的三级分析结构（即访问被聚集 反过来，患者聚集在车站中）。接下来，使用描述性统计信息，我们将计算出所有VHA EDS的ECSC的流行率，并确定任何VHA EDS的变化。最后，使用修改后的Delphi方法，我们将完善向退伍军人的ECSC列表。这些数据将对资深，ED-，系统和地理水平的高质量护理的预测指标设计和进行全国研究。