Development of an Adverse Event Surveillance System for Outpatient Surgery

门诊手术不良事件监测系统的开发

• 批准号: 8780231
• 负责人: Hillary Jane Mull
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8780231
• 关键词: Accident and Emergency department; Address; Admission activity; Adverse drug event; Adverse event; Ambulatory Care; Ambulatory Surgical Procedures; Area; Boston; Caring; Characteristics; Clinical Data; Collaborations; Communities; Data; Data Files; Data Sources; Databases; Detection; Development; Doctor of Philosophy; Electronics; Ensure; Evaluation; Event; Face; Feedback; Foundations; Frequencies; Funding; Future; Goals; Gold; Health Services Research; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Informatics; Interview; Joints; Knowledge; Lead; Leadership; Literature; Logistic Regressions; Measures; Medical center; Mentors; Mentorship; Methods; Mining; Modeling; Monitor; Nurses; Operative Surgical Procedures; Outcome; Outpatients; Patients; Private Sector; Probability; Procedures; Process; Program Evaluation; Provider; Qualifying; Qualitative Methods; Research; Research Personnel; Research Training; Resources; Safety; Sampling; Serious Adverse Event; Severities; Site; Structure; System; Testing; Training; Training Programs; Universities; Veterans; Visit; Wages; Work; Writing; base; career; demographics; design; economic outcome; electronic data; experience; health care quality; implementation research; implementation science; improved; innovation; medical schools; medical specialties; meetings; predictive modeling; professor; programs; research facility; response; skills; surgical research; tool

DESCRIPTION (provided by applicant): This is the second submission of an HSR&D CDA-2 proposal to provide four years of salary support to Hillary Mull, Ph.D. toward her goal of developing an independent VA health services research career. Dr. Mull is an Investigator at the Center for Healthcare Organization and Implementation Research (CHOIR), a joint HSR&D Center of Innovation (COIN) of two former Centers of Excellence, the Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System and the Center for Healthcare Quality Outcomes, and Economics Research (CHQOER) at the Bedford VAMC. Dr. Mull is also a Research Assistant Professor at the Boston University School of Medicine (BUSM) in the Department of Surgery. This CDA proposal outlines research and training plans that will set the foundation for Dr. Mull's future as an independent investigator with significant experience in applying healthcare informatics tools to detect outpatient adverse events (AEs). Her CDA goal is to improve quality and safety in outpatient surgery through the development and implementation of an AE surveillance system that uses trigger tools (TTs) to screen outpatient surgical data in the VA Corporate Data Warehouse (CDW). TTs are an emerging method that can increase the efficiency of the chart review process. TTs screen electronic clinical data to flag cases with a high probability of having an AE; cases are then briefly reviewed by a nurse to confirm the presence of any AE, and to rate the severity of the harm. In Aim 1, Dr. Mull will create a database of outpatient surgeries in VA through a mixed methods approach that uses qualitative interviews with surgical stakeholders to identify relevant variables associated with select TT outcomes (e.g., visit to the emergency department following outpatient surgery). These variables will be drawn from a modified Donabedian conceptual framework of structural, procedural and patient characteristics. Outpatient surgeries and surgical characteristics will be identified in VA electronic data sources including the CDW. In Aim 2, Dr. Mull will develop a TT surveillance system for outpatient surgery that uses predictive modeling to detect AEs among trigger-flagged cases. Aim 3 will implement the TT system in two VA surgical programs. Dr. Mull will use methods outlined in the Consolidated Framework for Implementation Research (CFIR) to conduct a formative evaluation of the implementation process, and summative evaluation of the effect of the TT system on AE rates and outpatient surgical quality. Dr. Mull's training plan focuses on bolstering her knowledge of healthcare informatics, qualitative program evaluation, and implementation science. Dr. Mull has a team of expert mentors (including Drs. Amy Rosen, Marty Charns, Kamal Itani, and Mary Hawn) and consultants (Drs. Peter Rivard, Steven Pizer, and Kathleen Hickson) who are qualified and strongly committed to helping her complete her CDA goals and establish herself as an independent HSR&D investigator. This mentorship, along with the rich resources available at CHOIR, will ensure that Dr. Mull has all the support necessary to meet her research and training aims. She will have access to CHOIR facilities, resources, and collaborations with exceptional HSR&D-funded investigators. Through this CDA, and in a QUERI SDP proposal planned for year 2 and an HSR&D pilot planned for year 4 of the CDA work, Dr. Mull proposes to develop and implement an AE surveillance system designed for outpatient surgery that can be used to target quality improvement efforts. The system can be broadly applicable to other outpatient settings, something we will explore in future research. Detecting and monitoring AEs in outpatient settings using existing data in the VA CDW is consistent with HSR&D funding priority C- Healthcare Informatics. This field of research will become even more important as care increasingly transitions from the hospital to the outpatient setting. Our results will provide much needed information about VA outpatient surgery to the research and surgical communities as they continue to measure and improve the quality of surgical care to our Veterans.

描述（由申请人提供）： 这是 HSR&D CDA-2 提案第二次提交，旨在为 Hillary Mull 博士提供四年的薪资支持。实现她发展独立的退伍军人事务部健康服务研究事业的目标。 Mull 博士是医疗保健组织和实施研究中心 (CHOIR) 的研究员，该中心是两个前卓越中心、组织、领导力和管理研究中心 (COLMR) 的联合 HSR&D 创新中心 (COIN)。 VA 波士顿医疗保健系统和位于贝德福德 VAMC 的医疗保健质量成果和经济研究中心 (CHQOER)。 Mull 博士还是波士顿大学医学院 (BUSM) 外科系的研究助理教授。 该 CDA 提案概述了研究和培训计划，这些计划将为 Mull 博士未来成为一名独立研究者奠定基础，他在应用医疗信息学工具检测门诊不良事件 (AE) 方面拥有丰富的经验。她的 CDA 目标是通过开发和实施 AE 监测系统来提高门诊手术的质量和安全性，该系统使用触发工具 (TT) 筛选 VA 企业数据仓库 (CDW) 中的门诊手术数据。 TT 是一种新兴方法，可以提高图表审核过程的效率。 TT 筛选电子临床数据，以标记出现 AE 的可能性较高的病例；然后由护士对病例进行简要审查，以确认是否存在任何不良事件，并评估伤害的严重程度。在目标 1 中，Mull 博士将通过混合方法创建 VA 门诊手术数据库，该方法使用与手术利益相关者的定性访谈来确定与选定 TT 结果相关的相关变量（例如，门诊手术后前往急诊室）。这些变量将从结构、程序和患者特征的改良多纳贝德概念框架中提取。门诊手术和手术特征将在 VA 电子数据源（包括 CDW）中确定。在目标 2 中，Mull 博士将为门诊手术开发 TT 监测系统，该系统使用预测模型来检测触发标记病例中的 AE。目标 3 将在两个 VA 手术项目中实施 TT 系统。 Mull 博士将使用实施研究综合框架 (CFIR) 中概述的方法对实施过程进行形成性评估，并对 TT 系统对 AE 发生率和门诊手术质量的影响进行总结性评估。 Mull 博士的培训计划侧重于增强她在医疗保健信息学、定性项目评估和实施科学方面的知识。 Mull 博士拥有一支由专家导师（包括 Amy Rosen 博士、Marty Charns、Kamal Itani 博士和 Mary Hawn 博士）和顾问（Peter Rivard 博士、Steven Pizer 博士和 Kathleen Hickson 博士）组成的团队，他们有资格并坚定地致力于帮助她完成她的 CDA 目标，并确立自己作为独立 HSR&D 调查员的地位。这种指导，加上合唱团提供的丰富资源，将确保马尔博士获得实现她的研究和培训目标所需的所有支持。她将可以使用 CHOIR 的设施、资源，并与 HSR&D 资助的杰出研究人员合作。 通过该 CDA，以及计划在 CDA 第 2 年制定的 QUERI SDP 提案和计划在 CDA 第 4 年制定的 HSR&D 试点计划，Mull 博士建议开发和实施专为门诊手术设计的 AE 监测系统，可用于实现质量目标改进努力。该系统可以广泛适用于其他门诊环境，我们将在未来的研究中探索这一点。使用 VA CDW 中的现有数据检测和监测门诊环境中的 AE 与 HSR&D 资助优先事项 C-医疗保健信息学一致。随着护理越来越多地从医院转移到门诊，这一研究领域将变得更加重要。我们的研究结果将为研究和外科界提供有关 VA 门诊手术的急需信息，因为他们将继续衡量和提高退伍军人的外科护理质量。

项目成果

Factors Associated with Hospital Admission after Outpatient Surgery in the Veterans Health Administration.

与退伍军人健康管理局门诊手术后入院相关的因素。

• 发表时间: 2018-10
• 影响因子: 3.4
• 作者: Mull, Hillary J;Rosen, Amy K;O'Brien, William J;McIntosh, Nathalie;Legler, Aaron;Hawn, Mary T;Itani, Kamal M F;Pizer, Steven D
• 通讯作者: Pizer, Steven D

The Nature and Severity of Adverse Events in Select Outpatient Surgical Procedures in the Veterans Health Administration.

退伍军人健康管理局部分门诊手术中不良事件的性质和严重程度。

• 发表时间: 2018
• 作者: Mull, Hillary J;Itani, Kamal M F;Charns, Martin P;Pizer, Steven D;Rivard, Peter E;Hawn, Mary T;Rosen, Amy K
• 通讯作者: Rosen, Amy K

Association Between Postoperative Admission and Location of Hernia Surgery: A Matched Case-Control Study in the Veterans Administration.

术后入院与疝气手术地点之间的关联：退伍军人管理局的匹配病例对照研究。

• 发表时间: 2016
• 影响因子: 16.9
• 作者: Mull, Hillary J;Rosen, Amy K;Pizer, Steven D;Itani, Kamal M F
• 通讯作者: Itani, Kamal M F

Defining Outpatient Surgery: Perspectives of Surgical Staff in the Veterans Health Administration.

定义门诊手术：退伍军人健康管理局外科人员的观点。

• 发表时间: 2016-11-01
• 作者: Mull, Hillary J;Rosen, Amy K;Rivard, Peter E;Itani, Kamal M F
• 通讯作者: Itani, Kamal M F

Development of an Adverse Event Surveillance Model for Outpatient Surgery in the Veterans Health Administration.

退伍军人健康管理局门诊手术不良事件监测模型的开发。

• 发表时间: 2018-12
• 影响因子: 3.4
• 作者: Mull, Hillary J;Itani, Kamal M F;Pizer, Steven D;Charns, Martin P;Rivard, Peter E;McIntosh, Nathalie;Hawn, Mary T;Rosen, Amy K
• 通讯作者: Rosen, Amy K