Improving Evidence-Based Quality of Care in Acute Stroke

提高急性中风的循证护理质量

基本信息

批准号：
7640687
负责人：
KAMAKSHI LAKSHMINARAYAN
金额：
$ 16.32万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-07-01 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7640687
关键词：
Acute Adherence Admission activity Age Area Aspirin Atrial Fibrillation Bypass Caregivers Caring Case Fatality Rates Characteristics Clinical Clinical Trials Clinical Trials Design Community Hospitals Coronary County Data Data Set Databases Deep Vein Thrombosis Deglutition Disorders Development Plans Disease Early treatment Electronics Event Fever Frequencies Funding Gender Glucose Goals Grant Heparin Home environment Hospitalization Hospitals Hour Insurance Coverage Intervention Intervention Studies Ischemic Stroke Joint Commission on Accreditation of Healthcare Organizations Link Lipids Measurement Measures Medical center Medicare Mentors Methods Metric Minnesota Minority Modeling Modification Morbidity - disease rate Neurologist Neurology Nursing Homes Outcome Outcomes and Health Services Research Pathway interactions Patients Physicians Pilot Projects Plasma Pneumonia Population Prophylactic treatment Protocols documentation Public Health Publishing Pulmonary Embolism Quality Indicator Quality of Care Race Recommendation Recurrence Rehabilitation therapy Research Research Personnel Research Project Grants Risk Risk Factors Screening procedure Secondary Prevention Services Severities Speech Pathology Stroke Survival Analysis System Testing Thrombolytic Therapy Time Translating Treatment Protocols United States United States Agency for Healthcare Research and Quality United States Centers for Medicare and Medicaid Services Warfarin Work Writing acute stroke base career career development community setting design disease natural history evidence base evidence based guidelines experience hypertension treatment improved male medical specialties mortality patient population population based post stroke subcutaneous therapy design

项目摘要

DESCRIPTION (provided by applicant): The candidate's long term professional goals are to develop an independent career in stroke research with a focus on quality of care, the impact of stroke care on patient outcomes and methods for improving the delivery of evidence-based care. To achieve these goals the candidate has developed a five-year career development plan involving a formal degree in Health Services Research (Outcomes Concentration) and the following mentored research project. Stroke mortality in the United States has declined rapidly in the 1970s and 1980s. However, this decline has slowed despite numerous advances in stroke treatments in the 1990s. The proposed research focuses on the evidence-practice gap as an explanation for the flattening of stroke mortality despite treatment advances in stroke care. We will use a population-based data set compiled in the Minneapolis-St. Paul area hospitals by the Project to Improve Stroke Care Management in Minnesota, an AHRQ funded clinical trial designed to examine the quality of acute ischemic stroke care. This database will be augmented by mortality data and by Medicare files compiled by the Center for Medicare and Medicaid Services. The proposed grant will use these data to accomplish the following aims: 1) Describe a comprehensive profile of outcomes in a population of patients hospitalized with acute ischemic stroke, 2) Model acute ischemic stroke outcomes in terms of care received, 3) Identify patient, clinician and hospital determinants of quality of stroke care. In addition, we will develop and pilot test an intervention designed to improve compliance with evidence-based quality of care indicators at one hospital. This pilot study will form the basis for a R01 grant designed to examine interventions for improving the delivery of evidence-based stroke care in community hospitals. Relevance to public health: Our work utilizes a population-based data set and hence our results on stroke outcomes will describe the natural history of the disease in a population of stroke patients. Our results on the determinants of quality of care have numerous public health implications since it will inform us as to the appropriate areas to target quality improvement initiatives. We anticipate that our pilot study will eventually be scaled to a larger study involving community hospitals.

描述（由申请人提供）：候选人的长期职业目标是在中风研究领域发展独立的职业生涯，重点关注护理质量、中风护理对患者结果的影响以及改善循证护理提供的方法。为了实现这些目标，候选人制定了五年职业发展计划，涉及健康服务研究（结果集中）的正式学位和以下指导研究项目。美国的中风死亡率在 20 世纪 70 年代和 80 年代迅速下降。然而，尽管 20 世纪 90 年代中风治疗取得了许多进展，但这种下降速度已经放缓。拟议的研究重点关注证据与实践之间的差距，以解释尽管中风护理方面的治疗取得了进展，但中风死亡率却趋于平缓。我们将使用在明尼阿波利斯-圣路易斯编制的基于人口的数据集。明尼苏达州改善中风护理管理项目是由 AHRQ 资助的临床试验，旨在检查急性缺血性中风护理的质量。该数据库将通过死亡率数据以及医疗保险和医疗补助服务中心编制的医疗保险文件进行扩充。拟议的拨款将使用这些数据来实现以下目标：1）描述因急性缺血性中风住院的患者群体的结果的综合概况，2）根据所接受的护理对急性缺血性中风结果进行建模，3）识别患者，临床医生和医院中风护理质量的决定因素。此外，我们将开发并试点测试一项干预措施，旨在提高一家医院对循证护理质量指标的依从性。这项试点研究将构成 R01 拨款的基础，该拨款旨在检查改善社区医院循证中风护理服务的干预措施。与公共卫生的相关性：我们的工作利用基于人群的数据集，因此我们对中风结果的结果将描述中风患者群体中疾病的自然史。我们关于护理质量决定因素的结果具有许多公共卫生影响，因为它将告诉我们针对质量改进举措的适当领域。我们预计我们的试点研究最终将扩大到涉及社区医院的更大规模的研究。