Outcomes in Children Undergoing Cardiac Catheterization

接受心导管插入术的儿童的结果

• 批准号: 9566371
• 负责人: Michael L O'Byrne
• 金额: $ 14.04万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-15 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9566371
• 关键词: Address; Adult; Adverse event; Advisory Committees; Affect; Benchmarking; Birth; Blood Vessels; Cardiac Catheterization Procedures; Catheterization; Catheters; Cessation of life; Child; Child Care; Childhood; Clinical; Clinical Markers; Clinical Research; Clinical Trials; Cohort Studies; Communication; Complex; Congenital Heart Defects; Data; Databases; Diagnostic; Diagnostic tests; Disease; Educational Activities; Epidemiology; Evaluation; Event; Faculty; Failure; Family; Gold; Health; Health Information System; Heart Diseases; Hospitalization; Inpatients; Institution; Insurance Carriers; Intervention; Knowledge; Laboratories; Lead; Life Expectancy; Link; Live Birth; Measures; Medical; Medicine; Mentors; Minor; Myocarditis; Outcome; Outcome Measure; Outcome Study; Parents; Patient Outcomes Assessments; Patients; Pediatric Cardiomyopathy; Perception; Physicians; Pilot Projects; Prevalence; Procedures; Process; Program Development; Pulmonary Hypertension; Quality of Care; Quality of life; Recovery; Registries; Reporting; Research Personnel; Risk; Sedation procedure; Severe Adverse Event; Severity of illness; Standardization; Structure; Surrogate Markers; Techniques; Testing; Time; Training; Training Programs; Work; administrative database; care delivery; career; career development; comparative effectiveness; cost; early childhood; economic cost; effectiveness research; frailty; functional status; hands on research; health care delivery; health care quality; health related quality of life; hemodynamics; high risk; improved; improved outcome; interest; malformation; mid-career faculty; mortality; non-invasive imaging; novel; public health relevance; satisfaction; skills; stressor; success; transmission process

 DESCRIPTION (provided by applicant): This proposal describes a five-year training program for the development of a career in clinical research, focused on improving the quality of cardiac catheterization in children. This proposal is will serve as a vehicle to developing into an independent investigator. To that end, we have established a training plan that includes mentoring, course-work, didactic educational activities, and hands-on research. Steven Kawut, MD, MS, (the primary mentor) is a tenured Associate Professor of Medicine and Epidemiology. He has a track record of successfully mentoring fellows and junior faculty and holds a K24 to support his mentoring activities. An advisory committee has been assembled to guide the candidate's career development. The application focuses on three specific aims. First, metrics to compare the outcomes of catheterization laboratories in different centers have not been defined. We have demonstrated that death and other catastrophic outcomes are significantly associated with procedural volume. However, the association between procedural volume and less severe adverse events was much less strong. We propose to study the association between procedural volume and risk of "failure to rescue" (i.e., the ability to avoid catastrophic outcome given an adverse event), and in so doing introduce it to as a novel outcome measure in the field. We propose to leverage a multi-center clinical registry, the IMproving Pediatric and Adult Treatment (IMPACT) registry to accomplish this aim. Second, economic cost is not only a surrogate marker of clinical outcome, but also an independent measure of the efficiency of healthcare delivery. We propose to establish benchmarks for the economic cost of catheterization procedures, and to study the factors influencing cost. To accomplish this aim, we will use a multi-center administrative database, the Pediatric Health Information System (PHIS) database. Third, patient-reported outcomes, such as health-related quality of life (HR-QOL) represent an important aspect of health that is not captured in traditional physician reported outcomes (and moreover are not included in multicenter registries and databases). They also represent an important aspect (along with cost) of comparative effectiveness research. We propose to perform a single center cohort study of children undergoing catheterization to define the effect of cardiac catheterization on HR-QOL, and to determine the factors (modifiable and non-modifiable) that influence it. Together, these three aims illuminate different outcomes associated with cardiac catheterization in children. By combining these novel techniques, the applicant hopes to begin to define the factors that influence health and well-being of children undergoing catheterization and set the groundwork for studies that will test interventions to improve the quality of care for children requiring cardiac catheterization.

 描述（由申请人提供）：该提案描述了一个为期五年的临床研究职业发展培训计划，重点是提高儿童心导管插入术的质量。该提案将作为发展为独立的工具。为此，我们制定了一项培训计划，包括指导、课程作业、教学教育活动和实践研究。 Steven Kawut，医学博士、理学硕士（主要导师）是一位医学和医学终身副教授。流行病学。拥有成功指导研究员和初级教师的记录，并拥有一个 K24 来支持他的指导活动，该申请重点关注三个具体目标。不同中心的导管插入实验室尚未确定。我们已经证明，死亡和其他灾难性后果与手术量显着相关，但是，我们建议研究手术量与不太严重的不良事件之间的关联。程序量和风险“救援失败”（即在发生不良事件时避免灾难性结果的能力），并在此过程中将其引入该领域作为一种新颖的结果衡量标准，即改善儿科。其次，经济成本不仅是临床结果的替代指标，也是衡量医疗服务效率的独立指标。导管插入术，并研究影响成本的因素。为了实现这一目标，我们将使用多中心管理数据库，即儿科健康信息系统（PHIS）数据库。第三，患者报告的结果，例如与健康相关的质量。生活质量（HR-QOL）代表了传统医生报告的结果中未涵盖的健康的一个重要方面（而且未包含在多中心登记和数据库中），它们也代表了比较有效性研究的一个重要方面（以及成本）。我们建议执行对接受导管插入术的儿童进行单中心队列研究，以确定心导管插入术对 HR-QOL 的影响，并确定影响它的因素（可修改和不可修改），这三项研究旨在阐明与心导管插入术相关的不同结果。通过结合这些新技术，申请人希望开始确定影响接受心导管插入术的儿童的健康和福祉的因素，并为测试干预措施以提高需要心导管插入术的儿童的护理质量的研究奠定基础。