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（由申请人提供）：Leyenaar 博士是塔夫茨大学医学院的一名儿科住院医生和儿科助理教授，她的目标是成为一名独立的临床医生兼研究者和住院儿童护理领域的全国领导者。 Leyenaar 博士提出的职业发展计划包括先进统计、定性方法、利益相关者参与和实施研究方面的指导研究和培训，作为临床博士学位的一部分。 Leyenaar 博士的导师团队在比较有效性框架中提供以患者为中心的结果研究方面的专业知识，指导她的职业发展。Lindenauer 博士是一位出色的研究者，在指导研究者走向独立研究职业方面有着丰富的经验。 Leyenaar 博士的工作环境非常有利于她的成功，她能够获得实现长期目标所需的所有资源。2012 年，美国有 180 万儿童住院治疗，总共产生了医疗费用。这些儿童中的大多数是通过急诊室 (ED) 入院的。对于病情稳定的儿童来说，直接入院是一种替代方法，无需在医院急诊室接受护理。及时获得门诊医疗保健提供者的帮助，直接入院可能会带来好处，包括改善医疗保健提供者之间的协调、减少急诊室数量和降低医疗费用，但是，直接入院的潜在风险包括初始评估和管理的延迟，这可能会对患者安全产生不利影响。博士的目标Leyenaar 的研究旨在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，她将通过以下方式实现这一目标：(1) 比较直接入院和急诊入院的常见临床状况的结果；(2a) 描述常见临床情况的结果。利益相关者在直接准入过程中的观点；(2b) 制定共识驱动的指南并确定直接准入的安全和质量指标；以及 (3) 试点测试实施该直接准入指南的可行性和可接受性。使用目标 2 将通过家长、医疗保健提供者的参与来完成，该数据库对美国不同结构的医院住院的儿童进行回顾性队列研究，开发先进的统计模型来比较直接入院的儿童与通过急诊室入院的儿童的结果。、付款人和政策制定者就他们的准入经验和观点进行深思熟虑的讨论，然后通过德尔菲流程制定直接准入指南，并优先考虑目标 3 将涉及该指南的实施。在一家医院进行了六个月的研究，产生了对后续研究以及 Leyenaar 博士成为独立研究者至关重要的数据。

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

Healthcare Quality for Children and Adolescents with Suicidality Admitted to Acute Care Hospitals in the United States.

美国急症护理医院收治的有自杀倾向的儿童和青少年的医疗保健质量。