Evaluating the safety and effectiveness of pediatric direct admissions to hospital

评估儿科直接入院的安全性和有效性

基本信息

批准号：
9293962
负责人：
JoAnna Leyenaar
金额：
$ 13.34万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-06 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9293962
关键词：
Evaluating safety effectiveness pediatric direct

项目摘要

DESCRIPTION (provided by applicant): Dr. Leyenaar is a pediatric hospitalist and Assistant Professor of Pediatrics at Tufts University School of Medicine. Her goal is to become an independent clinician-investigator and a national leader in the care of hospitalized children, focused on improving health care efficiency while providing patient-centered care. Dr. Leyenaar's proposed career development plan incorporates mentored research and training in advanced statistics, qualitative methods, stakeholder engagement and implementation research as part of a PhD in Clinical and Translational Science. Dr. Leyenaar's mentorship team brings expertise in patient-centered outcomes research in a comparative effectiveness framework, guiding her career development. Dr. Lindenauer, primary mentor, is an accomplished investigator with an established record of mentoring investigators toward independent research careers. Dr. Leyenaar works in an environment extremely supportive of her success, with access to all of the resources required to achieve her long-term goals. In 2012, 1.8 million children were hospitalized in the United States, generating aggregate costs of 20.6 billion dollars. The majority of these children were admitted to hospitals through emergency departments (ED). For children who are medically stable, direct admission is an alternative approach involving referral to hospital without receiving care in the hospital's ED. Among children with timely access to outpatient healthcare providers, direct admission may offer benefits including improved coordination between health care providers, reduced ED volumes, and reduced healthcare costs. However, potential risks of direct admissions include delays in initial evaluation and management that might adversely impact patient safety. The goal of Dr. Leyenaar's research is to identify the pediatric populations, healthcare settings, and procedures that facilitate safe and effective direct admissions. She will accomplish this goal by: (1) comparing the outcomes of direct and ED admissions for common clinical conditions; (2a) characterizing the perspectives of stakeholders in the direct admission process; (2b) developing a consensus-driven guideline and identifying safety and quality indicators for direct admissions; and (3) pilot test the feasibility and acceptability of implementing this direct admission guidelin. Aim 1 will be accomplished using a large administrative database to conduct a retrospective cohort study of children hospitalized at structurally diverse hospitals in the United States, developing advanced statistical models to compare outcomes among children admitted directly to those admitted via EDs. Aim 2 will be accomplished by engaging parents, healthcare providers, payers and policymakers in deliberative discussions about their admission experiences and perspectives, followed by a Delphi process to develop a direct admission guideline and prioritize quality indicators. Aim 3 will involve implementation of this guideline at one hospital for six months, generating data vital to subsequent studies and Dr. Leyenaar's emergence as an independent investigator.

描述（由应用程序提供）：Leyenaar博士是塔夫茨大学医学院的儿科住院医生和儿科助理教授。她的目标是成为独立的临床评估者，并成为住院儿童护理的国家领导者，重点是提高医疗保健效率，同时提供以患者为中心的护理。 Leyenaar博士提出的职业发展计划纳入了高级统计，定性方法，利益相关者参与和实施研究的指导研究和培训，这是临床和转化科学博士学位的一部分。 Leyenaar博士的心态团队在比较有效性框架中带来了以患者为中心的结果研究的专业知识，从而指导了她的职业发展。主要心态Lindenauer博士是一位有成就的研究者，具有既定的心态研究人员对独立研究职业的记录。 Leyenaar博士在一个极大地支持其成功的环境中工作，并获得了实现长期目标所需的所有资源。 2012年，美国有180万儿童住院，总费用为2006亿美元。这些孩子中的大多数通过急诊部门（ED）被送往医院。对于医学稳定的儿童，直接入院是一种替代方法，涉及转诊至医院的情况，而无需在医院的ED中接受护理。在及时获得门诊医疗保健提供者的儿童中，直接入院可能会提供福利，包括改善医疗保健提供者之间的协调，减少ED量和降低医疗费用。但是，直接入院的潜在风险包括初步评估和管理的延迟，可能会对患者的安全产生不利影响。 Leyenaar博士研究的目的是确定促进安全有效直接入院的儿科人群，医疗保健环境和程序。她将通过：（1）比较普通临床条件的直接和ED入学结果；（2a）在直接入学过程中表征利益相关者的观点；（2B）制定共识驱动的指南，并确定直接入院的安全和质量指标；（3）试点测试实施此直接录取Guidelin的可行性和可接受性。 AIM 1将使用大型行政数据库来完成，以进行回顾性的队列研究，对在美国结构多样化的医院住院的儿童进行回顾性队列研究，开发了先进的统计模型，以将直接接纳的儿童的结果与通过EDS接纳的儿童进行比较。 AIM 2将通过让父母，医疗保健提供者，付款人和政策制定者参与有关其录取经验和观点的讨论，然后进行Delphi程序，以制定直接入学指南并确定优先质量指标。 AIM 3将涉及实施本指南一家医院六个月，生成了对随后的研究至关重要的数据，以及Leyenaar博士作为独立研究者的出现。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review.

社区医院儿科住院护理的质量和安全：范围界定审查。

DOI：
10.12788/jhm.3268
发表时间：
2019
期刊：
Journal of hospital medicine
影响因子：
2.6
作者：
Leary,JanaC;Walsh,KathleenE;Morin,RebeccaA;Schainker,ElisabethG;Leyenaar,JoAnnaK
通讯作者：
Leyenaar,JoAnnaK

A Dark Horse Diagnosis.

黑马诊断。

DOI：
10.12788/jhm.3068
发表时间：
2018
期刊：
Journal of hospital medicine
影响因子：
2.6
作者：
McLaughlin,SaraKoenig;Carey,Adrienne;Houchens,Nathan;Meddings,Jennifer;Limaye,AjitP
通讯作者：
Limaye,AjitP

Paediatric hospital admission processes and outcomes: a qualitative study of parents' experiences and priorities.

DOI：
10.1136/bmjqs-2017-007442
发表时间：
2018-10
期刊：
BMJ quality & safety
影响因子：
5.4
作者：
Leyenaar JK;Rizzo PA;O'Brien ER;Lindenauer PK
通讯作者：
Lindenauer PK

Direct Admission to Hospital for Children in the United States.

直接入院美国儿童医院。

DOI：
10.1542/peds.2022-060973
发表时间：
2023
期刊：
Pediatrics
影响因子：
8
作者：
Leyenaar,JoAnnaK;Hill,Vanessa;Lam,Vinh;Stern,Rebecca;Vaughan,KristinWilliams;COMMITTEEONHOSPITALCARE
通讯作者：
COMMITTEEONHOSPITALCARE

The Unwritten Rules of Mentorship: Facilitators of and Barriers to Effective Mentorship in Pediatric Hospital Medicine.