The Impact of Public Reporting on Procedural Outcomes Following Congenital Heart Surgery

公开报告对先天性心脏病手术后手术结果的影响

• 批准号: 10371685
• 负责人: Natalie Jayaram
• 金额: $ 17.15万
• 依托单位: CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-28 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371685
• 关键词: Adult; Advocate; Area; Behavior; Cardiac Surgery procedures; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caregivers; Caring; Case Mixes; Characteristics; Child; Child Care; Childhood; Cities; Clinical; Complex; Comprehension; Coupled; Data; Data Analyses; Data Reporting; Databases; Development Plans; Diagnosis; Disclosure; Effectiveness; Ensure; Face; Faculty; Family; Focus Groups; Goals; Health; Health Personnel; Health Services; Healthcare; Heterogeneity; Hospitals; Inpatients; Institution; Investigation; Kansas; Life; Light; Mentorship; Methodology; Methods; Missouri; Nature; Operative Surgical Procedures; Outcome; Outcome Assessment; Outcomes Research; Parents; Patient Preferences; Patient Selection; Patient-Focused Outcomes; Patients; Pattern; Pediatrics; Policies; Policy Maker; Process; Provider; Qualitative Research; Quality of Care; Reporting; Research; Research Personnel; Risk; Sample Size; Science; Severities; Site; Time; Training; Training and Education; Travel; Universities; Work; base; care outcomes; career; career development; clinical care; congenital heart disorder; data format; design; experience; high risk; improved; improved outcome; meetings; member; mortality; operation; patient engagement; pediatric cardiologist; pediatric department; pediatric patients; preference; pressure; professor; profiles in patients; programs; skills; social; surgery outcome

PROJECT SUMMARY/ABSTRACT Natalie Jayaram, MD MSB is an Assistant Professor of Pediatrics at the University of Missouri-Kansas City and a faculty member in the Department of Pediatrics and Division of Cardiology at Children’s Mercy Hospital in Kansas City, Missouri. As a pediatric cardiologist and health services researcher, her long-term career goals are to improve the care of pediatric patients with congenital heart disease (CHD) by contributing to the science of quality assessment, by examining the effectiveness of policy-based initiatives on care, and by partnering directly with patients to facilitate changes in care. The goal of the current project is to study public reporting for congenital heart surgery (CHS). Public reporting is designed to provide healthcare consumers with outcome data for a given provider or institution. Proponents of public reporting advocate for transparent disclosure of health outcomes data and contend that public reporting results in improved outcomes.1-4 Critics of public reporting cite evidence that public reporting may not substantially improve outcomes and could result in unintended consequences, including risk avoidance practices.5-14 Formal study regarding the impact of public reporting on outcomes for CHS has never been performed. The highly specialized nature of CHD care, with relatively less local or regional competition compared to more prevalent conditions (e.g. adult cardiovascular disease) but with patients willing to travel to seek the ‘best’ care,15 suggest that public reporting for CHS warrants independent investigation. The primary aims of the proposed project are: 1) to evaluate whether, as an unintended consequence of public reporting, there is a shift in patient case mix, suggesting that centers could be avoiding surgical intervention in patients at highest risk for poor outcome 2) to evaluate the association between implementation of public reporting for CHS and surgical outcomes, and 3) to better understand the type and format of data that CHD patients and families would find most meaningful to help them make informed decisions regarding care. Study aims 1 and 2 of the project propose obtaining data from the State Inpatient Database in order to study the association between public reporting, institutional case mix, and surgical outcomes at centers throughout the US performing CHS. Study Aim 3 proposes focus groups involving CHD patients and caregivers to gain an improved understanding of their preferences with regards to public reporting. Together with her mentorship team, Dr. Jayaram has worked to create a career development plan that will provide her with additional training, education, and experience in the areas of advanced statistical methodology, experience in working with administrative data, and formal training in qualitative research and patient engagement. Overall, the skills learned from this project and educational plan coupled with an outstanding mentorship team will allow Dr. Jayaram to achieve her ultimate goal of becoming an independent investigator and leader in the field of pediatric cardiovascular outcomes research.

项目摘要/摘要 MSB MD的Natalie Jayaram是密苏里大学堪萨斯大学儿科助理教授 城市和儿童怜悯的儿科和心脏病学系的教职员工 密苏里州堪萨斯城的医院。作为儿科心脏病专家和卫生服务研究员，她的长期 职业目标是通过贡献先天性心脏病（CHD）的儿科患者的护理 通过检查质量评估科学，通过检查基于政策的护理计划的有效性以及 直接与患者合作以促进护理变化。当前项目的目的是公开学习 先天性心脏手术报告（CHS）。公开报告旨在为医疗保健消费者提供 带有给定提供商或机构的结果数据。公开报告倡导者的支持者透明 披露健康结果数据，并认为公开报告会导致结果改善。1-4批评家 公开报告引用证据表明，公开报告可能无法基本改善结果，并可能导致 意想不到的后果，包括避免风险惯例。5-14关于公众影响的正式研究 关于CHS结果的报告从未进行过。冠心病护理的高度专业性质， 与更普遍的条件相比，相对较少的本地或区域竞争（例如，成人心血管 疾病），但由于患者愿意旅行寻求“最佳”护理，15建议公开报告CHS 保证独立投资。拟议项目的主要目的是：1）评估是否是 公开报告的意想不到的结果，患者病例组合发生了变化，表明中心 可能避免对预后不良风险最高风险的患者进行手术干预2）评估 实施CHS和手术结果的公开报告之间的关联，以及3） 了解CHD患者和家庭最有意义的帮助的数据类型和格式 他们就护理做出明智的决定。研究目的是项目提案的1和2 国家住院数据库，以研究公共报告，机构案件组合之间的关联， 整个美国的中心的手术结果进行CHS。研究目标3个建议焦点小组 涉及冠心病患者和护理人员，以提高对他们在 公开报告。 Jayaram博士与她的Mentalship团队一起创造了职业发展 计划在高级统计领域为她提供额外的培训，教育和经验 方法论，在使用行政数据方面的经验以及定性研究中的正式培训和 病人参与。总体而言，从该项目和教育计划中学到的技能以及 杰出的Mentalship团队将允许Jayaram博士实现成为独立的最终目标 小儿心血管结局研究领域的研究者和领导者。