Unexpected death after medical encounters: Measurement, reporting, and analysis

医疗事故后的意外死亡：测量、报告和分析

基本信息

批准号：
8918327
负责人：
Ziad Obermeyer
金额：
$ 32.04万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-25 至 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8918327
关键词：
Accident and Emergency department Arrhythmia Cardiac Caring Case-Control Studies Cessation of life Chest Pain Clinic Clinical Clinical Data Comorbidity Consensus Country Data Data Analyses Databases Diagnostic tests EFRAC Economic Factors Elderly Emergency Care Emergency Situation Emergency department visit Event Frequencies Goals Health Information System Health Services Health care facility Health system Healthcare Home environment Hospitals Implantable Defibrillators Income Individual International Judgment Linguistics Link Location Measurement Measures Medical Medicare Medicare claim Methods Outpatients Patients Performance Pharmaceutical Preparations Phase Physicians Policy Maker Population Provider Quality of Care Recording of previous events Records Reporting Research Project Grants Risk Assessment Series Sudden Death Symptoms Syncope System Test Result Testing Training Unconscious State United States Social Security Administration Variant Visit Work administrative database base beneficiary clinical care cost design experience health care service organization high risk improved novel social

项目摘要

DESCRIPTION (provided by applicant): Of the 120 million patients seen annually in US Emergency Departments, 85% are discharged home, as are the vast majority of the one billion patients seen in ambulatory clinics. While rates of in-hospital deaths are routinely measured and reported, deaths outside of health facilities are far more challenging to capture because of fragmented health information systems both within and among health care organizations. As a result, providers have no systematic way of knowing when a patient dies unexpectedly after being sent home, and policy makers cannot readily measure how frequently these catastrophic events occur. I propose a series of linked research projects to track and analyze unexpected deaths after medical encounters, using data from a large academic hospital system as well as Medicare claims, in order to identify factors related to individual patients, providers, and system that increase the likelihood of such events. I will subsequently adapt the methods to an international setting, where clinical and administrative data are less complete than in the US. This work would have important implications for improving both clinical care and health services design. In addition, a systematic method for tracking and reporting rates of unexpected early deaths would be a useful way to measure health services performance, and assess trade-offs between quality and cost.

描述（由申请人提供）：在美国急诊科每年接诊的 1.2 亿患者中，85% 出院回家，门诊诊所接诊的 10 亿患者中的绝大多数也是如此。虽然院内死亡率是常规测量和报告的，但由于卫生保健组织内部和之间的卫生信息系统支离破碎，统计卫生机构外的死亡人数要困难得多。因此，医疗服务提供者没有系统的方法来了解患者何时在被送回家后意外死亡，政策制定者也无法轻松衡量这些灾难性事件发生的频率。我提出了一系列相互关联的研究项目，利用来自大型学术医院系统以及医疗保险索赔的数据来跟踪和分析医疗遭遇后的意外死亡，以确定与个体患者、提供者和系统相关的因素，这些因素会增加意外死亡的可能性此类事件。随后，我将调整这些方法以适应国际环境，因为国际环境中的临床和管理数据不如美国完整。这项工作将对改善临床护理和卫生服务设计产生重要影响。此外，跟踪和报告意外早期死亡率的系统方法将是衡量卫生服务绩效和评估质量与成本之间权衡的有用方法。