Assessing Hospital Quality of Care for Patients with Multimorbidity

评估医院对多种疾病患者的护理质量

• 批准号: 9816049
• 负责人: JEFFREY H SILBER
• 金额: $ 56.69万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9816049
• 关键词: American Hospital Association; Caring; Categories; Characteristics; Clinical; Comorbidity; Control Groups; Country; Data; Department chair; Diagnosis; Discipline of Nursing; Environment; Goals; Hospitals; Individual; Institution; Investigation; Leadership; Legal patent; Medical; Medicare claim; Methods; Operative Surgical Procedures; Outcome; Outpatients; Pathway interactions; Patient Care; Patient risk; Patient-Focused Outcomes; Patients; Pattern; Population Control; Procedures; Qualifying; Quality of Care; Reporting; Research; Research Personnel; Risk; Standardization; System; Time; Work; cost; dashboard; hospital performance; improved; indexing; innovation; insight; mortality; multiple chronic conditions; off-patent; quality improvement organization; secondary analysis; synergism; virtual

Abstract At present, it is difficult for hospitals to assess the care of their multimorbid (MM) patients. Since multimorbidity is by definition individualized by many possible combinations of comorbidities and principal diagnoses, any single hospital cannot determine whether their care was optimal for their MM patients, since hospitals do not have access to closely matched controls from other hospitals that may provide insight into how their own MM patients may have fared at other institutions. Since multimorbid patients are far sicker than other patients, it may also be easy to dismiss individual poor outcomes as merely part of the natural pathway associated with multimorbidity. The goal of this proposal is to aid hospitals in observing how their MM patient outcomes differ from similar patients treated at other institutions. Using new definitions of MM in hospitalized surgical and medical patients that specifically define single, double and triple combinations of comorbidities that comprise qualifying comorbidity sets, this study examines whether hospitals vary in their ability to optimally treat MM patients. Results from this study will be directly actionable as an aid to inform hospitals how they fare with their specific MM patients as compared to how their patients may have fared elsewhere. The project will use Medicare claims from the entire country through the new CMS VRDC (Virtual Data Research Center), thereby facilitating a large control group to make close comparisons for any given hospital's patients, and apply new methods in multivariate matching (Indirect Standardization Matching "ISM") developed by the investigators, to examine quality of care for MM patients. Using ISM, we will produce 10 “copies” (or control patients matched from patients admitted to hospitals outside the index hospital) for each MM patient at an index hospital, allowing for close matching of specific qualifying comorbidity sets, and close examination of how well the hospital treats MM patients compared to the closest matched patients selected from other hospitals. Using multivariate matching, we will also examine hospital characteristics that may be associated with better outcomes in MM patients. The project has 4 aims: AIM 1: For every hospital performing study conditions or procedures, determine if their MM patient outcomes are significantly different than matched controls. Two control populations will be utilized, a representative control population and a control population selected from hospitals with a combination of characteristics associated with superior outcomes (derived from AIM 2). AIM 2: Identify types of hospitals that have especially good or especially poor outcomes when treating MM patients as compared to other closely matched patients derived from two control populations at other hospitals. AIM 3 will examine specific patient qualifying comorbidity sets that present the greatest problems for a hospital (or type of hospital). Finally, AIM 4 will develop outcomes reports for hospitals, with the help of the American Hospital Association. Such reports will allow individual hospitals to gain insight, for the first time, into how their MM patient outcomes compare to extremely similar MM controls.

抽象的 目前，医院很难评估其多病（MM）患者的护理。由于多种繁殖 根据定义，合并症和主要诊断的许多可能组合，任何可能 单身医院无法确定他们的护理是否最适合其MM患者，因为医院没有 可以访问其他医院的紧密匹配的控制 患者可能已经在其他机构进行了。由于多重病患者比其他患者病得多，因此 作为与之相关的自然途径的一部分，可能很容易驳斥个人差的结果 多种病。该建议的目的是帮助医院观察其MM患者结果如何不同 来自其他机构接受治疗的类似患者。在住院的手术和 专门定义了完成合并症的单一，双重和三重组合的医学患者 合并症合并的合并症集，这项研究检查医院的最佳治疗能力是否有所不同 患者。这项研究的结果将直接采取行动，以告知医院如何与他们的票价 特定的MM患者与患者在其他地方的表现相比。该项目将使用 Medicare通过新的CMS VRDC（虚拟数据研究中心）从整个国家索赔，从而 促进一个大型对照组，对任何给定医院的患者进行密切比较，并申请新的 研究人员开发的多元匹配（间接标准化匹配“ ISM”）中的方法 检查MM患者的护理质量。使用ISM，我们将生产10个“副本”（或对照患者匹配 从指数医院外的医院录取的患者）在指数医院的每位MM患者） 允许密切匹配特定的合并症集，并仔细检查 医院治疗MM患者与其他医院选择的最接近的患者相比。使用 多元匹配，我们还将检查可能与更好的医院特征 MM患者的结果。该项目有4个目标：目标1：对于每个医院进行学习条件或 程序，确定其MM患者结果是否与匹配的对照组显着不同。二 控制人群将被利用，代表性控制人群和从中选择的对照人群 具有与出色结果相关的特征（源自AIM 2）的特征相结合的医院。目标2： 确定在将MM患者视为时具有特别好或特别差的医院 与其他医院的两个对照人群得出的其他密切匹配的患者相比。目标3意志 检查特定的患者合并合并症集，这些合并症集给医院带来最大问题（或类型 医院）。最后，AIM 4将在美国医院的帮助下为医院制定结果报告 协会。此类报告将使各个医院能够首次了解其MM 患者结果与极其相似的MM对照相比。