The Value of Pediatric Readiness in the Emergency Care of Injured Children

儿科准备在受伤儿童紧急护理中的价值

• 批准号: 9208558
• 负责人: Craig D. Newgard
• 金额: $ 58.96万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9208558
• 关键词: Accident and Emergency department; Accidental Injury; Accreditation; Acute; Address; Affect; American College of Surgeons; Area; Caring; Cause of Death; Child; Child Care; Childhood; Childhood Injury; Cohort Analysis; Communities; Complex; Contingent Negative Variation; Data; Data Set; Data Sources; Decision Analysis; Emergency Care; Emergency Situation; Emergency medical service; Engineering; Enrollment; Environment; Equilibrium; Equipment; Event; Geographic Locations; Goals; Health; Health Policy; Health system; Healthcare Systems; Hospitals; Injury; Injury Severity Score; Inpatients; Institute of Medicine (U.S.); Investigation; Life; Link; Measures; Outcome; Outcome Measure; Participant; Patient risk; Patient-Focused Outcomes; Patients; Policies; Policy Maker; Provider; Public Health; Quality of Care; Readiness; Reporting; Research; Research Design; Research Personnel; Resources; Science; System; Testing; Time; Trauma; Trauma Research; United States; big biomedical data; care seeking; care systems; cohort; cost; cost effective; data resource; demographics; high risk; improved; injured; multidisciplinary; novel; patient oriented; pediatric department; pediatric trauma; policy implication; population based; programs; repository; trauma care; trauma centers; years of life lost

Proposed Approach: We will develop a novel 24-state cohort of injured children presenting to emergency departments (EDs) over an 8-year period. We will then use this research data resource and an inter- disciplinary team to describe and evaluate the value of “pediatric readiness” in the emergency care of injured children. Importance: Unintentional injury remains the leading cause of death and years of potential life lost in children. Use of emergency services following injury is common, with large variability in the readiness to care for injured children. While several national and state efforts have sought to improve pediatric readiness, it remains unclear whether increased readiness improves quality and health outcomes, and at what cost. This project seeks to build a unique data resource for the scientific community and to use this resource and an inter-disciplinary team to rigorously evaluate the emergency care system for injured children in terms of quality, outcomes and costs. This project will fill key scientific gaps in pediatric trauma care and seeks to identify a re-engineered, high-value emergency care system for injured children that optimizes quality, outcomes and costs. Objectives: The proposal has 3 specific aims: Specific Aim 1. To build a novel 24-state research data resource and use these data to describe and quantify the emergency care of injured children in the context of pediatric readiness, including out-of-hospital, ED and inpatient care. Specific Aim 2. To evaluate how pediatric readiness affects the quality of care, health outcomes and costs of care for injured children. Specific Aim 3. To assess the value of pediatric readiness in the emergency care of injured children, including the balance of quality, outcomes and costs. Study Design: This will be a cohort analysis of a 24-state, population-based cohort of injured children presenting to 2,280 EDs in 24 states. Nine unique data sources will be matched at the patient level to create the master dataset. “Pediatric readiness” will be defined using a variety of EMS, ED and hospital measures. Setting: The setting includes 2,280 hospitals in 24 states, representing diverse facilities, geographic regions, patient demographics, pediatric readiness and systems of care. Participants: The study will enroll 21.6 million injured children 0 – 19 years presenting to 2,280 EDs following an injury event from 1/1/2012 through 12/31/2019, representing the entire denominator of injured children seeking emergency services in these states. The cohort will include 541,096 children with serious injuries (Injury Severity Score ≥ 16), representing high-risk patients. Outcome measures: We will evaluate 12 pediatric trauma quality measures, 2 patient-centered outcomes and acute care costs.

提出的方法：我们将开发出一个新颖的24个国家队列的受伤儿童，向紧急情况展示 部门（ED）在8年期间。然后，我们将使用此研究数据资源和一个间 纪律团队描述和评估“小儿准备”在受伤的紧急护理中的价值 孩子们。 重要性：无意的伤害仍然是死亡的主要原因和儿童潜在生命的多年生命。 受伤后的紧急服务使用很常见，愿意照顾受伤的人有很大的变化 孩子们。尽管几项国家和州的努力试图改善小儿准备，但尚不清楚 准备就绪是否可以改善质量和健康成果，以及以多少代价。这个项目试图 为科学界建立独特的数据资源，并使用此资源和跨学科 团队在质量，结果和 费用。该项目将填补小儿创伤护理中的关键科学空白，并试图确定重新设计的， 针对受伤儿童的高价值紧急护理系统，可优化质量，结果和成本。 目标：该提案具有3个具体目标： 特定目的1。建立一种新颖的24州研究数据资源并使用这些数据来描述和量化 在小儿准备就绪的情况下，受伤儿童的急诊护理，包括医院外，ED和 住院护理。 具体目标2。评估儿科准备如何影响护理质量，健康成果和成本 照顾受伤的孩子。 特定目的3。评估受伤儿童急诊护理小儿准备的价值，包括 质量，成果和成本的平衡。 研究设计：这将是对受伤儿童的24个州，基于人群的队列的队列分析 在24个州展示2280次ED。九个独特的数据源将在患者级别匹配以创建 主数据集。将使用各种EMS，ED和医院测量来定义“小儿准备”。 设置：设置包括24个州的2,280家医院，代表潜水设施，地理区域， 患者人口统计，小儿准备和护理系统。 参与者：这项研究将注册2160万受伤儿童0 - 19岁以后，EDS 2,280 ED 2012年1月1日至12/31/2019的伤害事件，代表整个受伤儿童的分母 在这些州寻求紧急服务。该队列将包括541,096名严重受伤的儿童 （损伤严重程度评分≥16），代表高危患者。 结果指标：我们将评估12个儿科创伤质量指标，2种以患者为中心的结果和 急性护理费用。