Unexpected death after medical encounters: Measurement, reporting, and analysis

医疗事故后的意外死亡：测量、报告和分析

基本信息

批准号：
9136683
负责人：
Ziad Obermeyer
金额：
$ 31.75万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-25 至 2017-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9136683
关键词：
Accident and Emergency department Arrhythmia Cardiac Caring Case-Control Studies Cessation of life Chest Pain Clinic Clinical Clinical Data Comorbidity Consensus Country Data Data Analyses Databases Diagnostic tests EFRAC Economic Factors Elderly Emergency Care Emergency Situation Emergency department visit Event Frequencies Goals Health Information System Health Services Health care facility Health system Healthcare Home environment Hospitals Implantable Defibrillators Income International Judgment Linguistics Link Location Measurement Measures Medical Medicare Medicare claim Methods Outpatients Patients Performance Pharmaceutical Preparations Phase Physicians Policy Maker Population Provider Quality of Care Recording of previous events Records Reporting Research Project Grants Risk Assessment Series Sudden Death Symptoms Syncope System Test Result Testing Training Unconscious State United States Social Security Administration Variant Visit Work administrative database base beneficiary clinical care cost design experience health care service organization high risk improved individual patient novel social

项目摘要

DESCRIPTION (provided by applicant): Of the 120 million patients seen annually in US Emergency Departments, 85% are discharged home, as are the vast majority of the one billion patients seen in ambulatory clinics. While rates of in-hospital deaths are routinely measured and reported, deaths outside of health facilities are far more challenging to capture because of fragmented health information systems both within and among health care organizations. As a result, providers have no systematic way of knowing when a patient dies unexpectedly after being sent home, and policy makers cannot readily measure how frequently these catastrophic events occur. I propose a series of linked research projects to track and analyze unexpected deaths after medical encounters, using data from a large academic hospital system as well as Medicare claims, in order to identify factors related to individual patients, providers, and system that increase the likelihood of such events. I will subsequently adapt the methods to an international setting, where clinical and administrative data are less complete than in the US. This work would have important implications for improving both clinical care and health services design. In addition, a systematic method for tracking and reporting rates of unexpected early deaths would be a useful way to measure health services performance, and assess trade-offs between quality and cost.

描述（由申请人提供）：在美国急诊室每年见到的1.2亿患者中，有85％的患者已出院，而在非洲卧床诊所中看到的十亿名患者中的绝大多数也是如此。尽管常规衡量和报告了院内死亡率，但由于卫生保健组织内部和之间，医疗机构以外的死亡人数更具挑战性，因此更具挑战性。结果，提供者没有系统地知道患者何时被送回家后出乎意料的死亡，而决策者无法轻易衡量这些灾难性事件的发生频率。我提出了一系列相关的研究项目，以使用大型学术医院系统以及Medicare索赔的数据跟踪和分析意外的死亡，以确定与个别患者，提供者和系统相关的因素，从而增加了此类事件的可能性。随后，我将将这些方法调整到国际环境中，在国际环境中，临床和行政数据的完整程度不如美国。这项工作将对改善临床护理和卫生服务设计具有重要意义。此外，跟踪和报告意外早期死亡率的系统方法将是衡量卫生服务绩效并评估质量和成本之间的权衡的有用方法。

项目成果

期刊论文数量（21）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Lost in Thought - The Limits of the Human Mind and the Future of Medicine.

DOI：
10.1056/nejmp1705348
发表时间：
2017-09-28
期刊：
The New England journal of medicine
影响因子：
0
作者：
Obermeyer Z;Lee TH
通讯作者：
Lee TH

Predicting the Future - Big Data, Machine Learning, and Clinical Medicine.

DOI：
10.1056/nejmp1606181
发表时间：
2016-09-29
期刊：
The New England journal of medicine
影响因子：
0
作者：
Obermeyer Z;Emanuel EJ
通讯作者：
Emanuel EJ

Short-term Mortality Prediction for Elderly Patients Using Medicare Claims Data.

DOI：
10.7763/ijmlc.2015.v5.506
发表时间：
2015-06
期刊：
International journal of machine learning and computing
影响因子：
0
作者：
Makar M;Ghassemi M;Cutler DM;Obermeyer Z
通讯作者：
Obermeyer Z

Prediction Policy Problems.

DOI：
10.1257/aer.p20151023
发表时间：
2015-05
期刊：
The American economic review
影响因子：
0
作者：
Kleinberg J;Ludwig J;Mullainathan S;Obermeyer Z
通讯作者：
Obermeyer Z

Short-term Outcomes for Medicare Beneficiaries After Low-acuity Visits to Emergency Departments and Clinics.

医疗保险受益人在急诊室和诊所进行低度就诊后的短期结果。

DOI：
10.1097/mlr.0000000000000513
发表时间：
2016
期刊：
Medical care
影响因子：
3
作者：
Niedzwiecki,Matthew;Baicker,Katherine;Wilson,Michael;Cutler,DavidM;Obermeyer,Ziad
通讯作者：
Obermeyer,Ziad