Role of individual and hospital factors in quality of care for children in EDs

个人和医院因素对急诊科儿童护理质量的作用

• 批准号: 10297524
• 负责人: Margaret Emily Samuels-Kalow
• 金额: $ 43.33万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10297524
• 关键词: Accident and Emergency department; Accounting; Address; Admission activity; Affect; Caring; Case Mixes; Characteristics; Child; Child Care; Child Health; Childhood; Clinical; Data; Databases; Emergency Care; Emergency Medicine; Emergency department visit; Ensure; Equipment; Equipment and supply inventories; Ethnic Origin; Evidence based intervention; Face; Geography; Goals; Grant; Health Care Costs; Health Services Research; Hospital Mortality; Hospitals; Image; Individual; Inpatients; Insurance; Insurance Coverage; Interview; Investigation; Knowledge; Link; Measures; Mediator of activation protein; Minority; Mission; National Institute of Child Health and Human Development; Nurses; Outcome; Patients; Pediatric Hospitals; Physicians; Policies; Population; Process; Public Health; Quality of Care; Race; Readiness; Research; Resources; Role; Strategic Planning; System; Time; Training; Travel; United States; United States Agency for Healthcare Research and Quality; Variant; Visit; Work; administrative database; adolescent health; care outcomes; disparity reduction; emergency settings; experience; health care disparity; health care service utilization; health disparity; implementation determinants; improved; improved outcome; interest; medical specialties; member; mortality; multilevel analysis; pediatric emergency; pediatric patients; social

Abstract Although most children receive emergency care in general emergency departments (EDs), national studies have shown that pediatric readiness is low and that the lack of readiness has consequences for clinical quality and outcomes. Presentation to a highly prepared hospital, one with a high pediatric readiness score, is associated with decreased in-hospital mortality. Presence of a pediatric emergency care coordinator (PECC) is associated with increased readiness, but limited data are available to directly assess the association between PECC status and quality of care for children. Previous work has focused primarily on quality variation among specialty pediatric centers which account for a minority of care provided to pediatric patients and have very different staffing and resources as compared to general EDs. Our long-term goal is to develop systems to improve care for children presenting to general EDs. The goal of this R01 project is to define the hospital-level characteristics associated with quality of care provided to children in general EDs. We will use a slate of recently developed process and outcome quality measures across geographically diverse states with high- quality pediatric data available. Our primary hypothesis is that more intensive pediatric-focused staffing (e.g. more robust PECC implementation) is associated with higher-quality care and better clinical outcomes for children. The specific aims are to (1) Identify PECC implementation factors that are associated with variation in quality of emergency care for children (2) Establish if PECC status is associated with higher quality of care for children treated in general EDs and (3) Determine if disparities in quality of care by race/ethnicity and insurance vary by PECC status. The proposed work builds on our pilot work with the National ED Inventory (NEDI-USA) database, as well as on our team’s strong track record in health services research with large administrative databases and qualitative and implementation expertise. In the proposed work, we fulfill two of the primary goals of the NICHD Strategic Plan: (1) “improving child and adolescent health” and (2) addressing “pervasive disparities…improving approaches in populations that experience specific cultural, social, or access issues.” These data will provide a critical understanding of the association between PECC, workforce factors, and quality of care for children. This understanding is the prerequisite for developing evidence-based interventions to improve outcomes for all children receiving emergency care in general EDs.

抽象的 尽管大多数儿童在一般急诊科（ED）中接受急诊护理，但国家研究 已经表明，小儿准备就绪低，缺乏准备对临床质量产生了影响 和结果。向一家准备好的医院介绍，一家患有较高儿科准备得分的医院是 与院内死亡率降低有关。小儿急诊协调员（PECC）的存在为 与提高准备性相关，但数据可直接评估 PECC儿童的护理状况和护理质量。以前的工作主要集中于质量变化 专业的儿科中心是为儿科患者提供的少数护理，并且非常有 与一般ED相比，不同的人员配备和资源。我们的长期目标是开发系统 改善向一般ED的儿童护理。这个R01项目的目标是定义医院级别 与一般ED儿童提供的护理质量相关的特征。我们将使用一块 最近开发了各种地理位置各州的过程和结果质量措施， 可用的优质小儿数据。我们的主要假设是，更密集的小儿人员配备人员（例如 更强大的PECC实施）与高质量的护理和更好的临床结果有关 孩子们。具体目的是（1）确定与变化有关的PECC实施因素 儿童紧急护理质量（2）确定PECC状态是否与更高的护理质量有关 在一般急诊室接受治疗的儿童和（3）确定根据种族/种族的护理质量差异和 保险因PECC身份而异。拟议的工作是基于我们与国家ED库存的飞行员合作的基础 （NEDI-USA）数据库，以及我们团队在健康服务研究方面的良好往绩， 行政数据库以及定性和实施专业知识。在拟议的工作中，我们完成了两个 NICHD战略计划的主要目标：（1）“改善儿童和青少年健康”和（2）解决 “普遍分布……改善人群中经验特定文化，社会或访问的方法 问题。”这些数据将对PECC，劳动力因素， 和儿童的护理质量。这种理解是开发基于证据的先决条件 为了改善所有接受急诊护理的儿童的干预措施。