The PIPA (Pediatric Inpatient Patient Pathways for Asthma) Study: Optimizing Quality of Hospital Care for Children with Asthma

PIPA（儿童哮喘住院患者路径）研究：优化哮喘儿童的医院护理质量

• 批准号: 9088983
• 负责人: Sunitha Vemula Kaiser
• 金额: $ 14.58万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9088983
• 关键词: PIPA; Pediatric; Inpatient; Patient; Pathways

 DESCRIPTION (provided by applicant): This is an application for a K08 award for Sunitha Kaiser, MD MSc, a pediatric hospitalist at the University of California, San Francisco. Dr. Kaiser is establishing herself as a young investigator in accelerating use of evidence-based guidelines in clinical practice to improve quality of hospital care for children, an AHRQ priority population. This award will provide Dr. Kaiser with the support necessary to accomplish the following goals: (1) to become expert in qualitative research methods and implementation science; (2) to gain experience in conducting a trial; (3) to gather preliminary data for the purpose of designing a multi-site trial; and (4) to develop an independent clinical research career. To achieve these goals, Dr. Kaiser has assembled a multi- disciplinary mentoring committee whose expertise spans the relevant disciplines of asthma and clinical trials (Drs. Cabana, McCulloch and Horwitz), health services research (Drs. Auerbach, Cabana, McCulloch, and Horwitz), qualitative research (Dr. Rehm), and implementation science (Drs. Auerbach, Cabana, and Horwitz). Asthma is the second most common cause of pediatric hospitalizations1 in the United States, resulting in nearly $1 billion in annual costs. Despite broad dissemination of evidence-based guidelines for asthma management, there are significant variations in care and risk-adjusted outcomes for children hospitalized with asthma, largely due to challenges integrating guidelines into care. Clinical pathways are structured, multidisciplinary, and detailed care plans for patients with a specific clinical problem; they link evidence to practice to optimize patient outcomes and delivery efficiency. In controlled trials, pathways reduce inappropriate variation in care and improve outcomes for children hospitalized with asthma by both increasing home asthma management education and decreasing hospital length of stay. However, there is wide variability in performance and uptake of pediatric asthma pathways in real-world settings due to a dearth of evidence- based guidance on successful implementation methods. Dr. Kaiser's long-term goal is to become an independent investigator who leads efforts to improve quality of care for hospitalized children by accelerating use of evidence-based guidelines in clinical practice. Dr. Kaiser's objective is to identify, test, and disseminate best practices for pathway implementation to improve quality of care for children hospitalized with asthma. The central hypothesis, derived from the "positive deviance" approach, is that identification and examination of hospitals that demonstrate exceptional performance with pathway implementation can facilitate the discovery and wide dissemination of strategies to improve care. Steps in this mixed-methods approach include: 1) identify hospitals where pathway implementation led to the largest gains in performance, 2) study these hospitals using qualitative methods to identify best practices associated with high performance, and 3) test these best practices with rigorous design. The rationale is that high-performing hospitals will have replicable pathway implementation practices that will be critical to widespread national uptake, ultimately leading to consistent delivery of evidence-based practices and higher quality of care. This hypothesis will be tested by pursuing three specific aims: Aim 1) Identify hospitals where implementation of inpatient pediatric asthma pathways has led to the largest improvements in quality of care. Key personnel from 43 children's hospitals that contribute to a national administrative database will be surveyed to determine if and when asthma pathways were implemented, then the database will be used to identify which hospitals had the greatest gains in quality of care with pathway implementation. Aim 2) Determine best practices for implementation of inpatient pediatric asthma pathways through in-depth qualitative analysis of key personnel from the high-performing hospitals identified in Aim 1. Aim 3) Conduct a pilot trial to determine the feasibilityof implementing inpatient pediatric asthma pathways utilizing best practices in both a tertiary and community hospital setting. This pilot trial will enroll 50 total children hospitalized with asthma The proposed research is innovative to pediatric clinical pathway research both by shifting the traditional approach to focus on implementation strategies and by utilizing a novel mixed-methodology, based on the concept of "positive deviance." The proposed research is significant because it is expected to vertically advance and expand knowledge on best practices for pathway implementation, which will enable increased uptake and successful implementation of clinical pathways in both tertiary and community settings, thereby improving evidence-based practices and quality of care for children with asthma. Ultimately, this new knowledge could support pathway implementation across a range of pediatric illnesses to improve quality of care and decrease unnecessary costs.

 描述（由申请提供）：这是加利福尼亚大学旧金山分校的儿科住院医生Sunitha Kaiser的K08奖。 Kaiser博士正在建立自己是一名年轻的研究者，以加速使用基于证据的准则在临床实践中使用基于证据的准则，以提高AHRQ优先人群的儿童医院护理质量。 该奖项将为Kaiser博士提供实现以下目标所需的支持：（1）成为定性研究方法和实施科学专家； （2）获得进行试验的经验； （3）收集初步数据以设计多站点试验； （4）发展独立的临床研究职业。 To achieve these goals, Dr. Kaiser has assembled a multi-disciplinary mentoring committee whose expertise spans the relevant disciplines of asthma and clinical trials (Drs. Cabana, McCulloch and Horwitz), health services research (Drs. Auerbach, Cabana, McCulloch, and Horwitz), qualitative research (Dr. Rehm), and implementation science (Drs. Auerbach, Cabana,和Horwitz）。哮喘是美国小儿住院的第二大原因1，导致近10亿美元的年费用。尽管对哮喘管理的基于证据的指南进行了广泛的传播，但对住院的儿童的护理和风险调整后的结果有很大的差异，这在很大程度上是由于将指南整合到护理中的挑战。临床途径是针对患有特定临床问题的患者的结构化，多学科和详细的护理计划；他们将证据与实践联系起来，以优化患者的结果和分娩效率。在对照试验中，途径减少了护理的不当变化，并通过增加家庭哮喘管理教育和医院住院时间来改善哮喘住院的儿童。但是，由于基于证据的成功实施方法的指导死亡，在现实世界中，儿科哮喘途径的性能和吸收差异很大。 Kaiser博士的长期目标是成为一名独立研究者，他通过加速在临床实践中加速使用基于证据的准则来提高住院儿童的护理质量。 Kaiser博士的目标是确定，测试和传播实施途径的最佳实践，以改善患有哮喘住院的儿童的护理质量。源自“积极偏差”方法的中心假设是，对医院的识别和检查证明了通过实施途径表现出色表现的医院，可以促进发现和广泛传播改善护理的策略。这种混合方法方法的步骤包括：1）确定途径实施导致绩效增长最大的医院，2）使用定性方法研究这些医院，以识别与高性能相关的最佳实践，3）用严格的设计测试这些最佳实践。理由是，高性能医院将具有可复制的途径实施实践，这对于广泛的民族吸收至关重要，最终导致 一致地提供基于证据的实践和更高的护理质量。该假设将通过追求三个具体目标来检验：目标1）确定医院实施住院儿科哮喘途径已导致护理质量的最大改善。来自43家儿童医院的关键人员将调查为国家行政数据库做出贡献，以确定是否以及何时实施哮喘路径，然后是数据库目标2）确定实施住院儿科哮喘通路的最佳实践，通过对高度验证的关键人员的定性分析，以确定fitot finot in Ementibility in Embotibility in Embotibility in Ementiment firot in Ementimition in Ementiment in Ementiment fient in Ementimition in act act act act act act act act act ai。在三级和社区医院环境中，使用最佳实践的住院儿科哮喘途径。这项试验试验将招募50名患有哮喘的儿童，这项拟议的研究通过将传统的方法转移到实施策略上，并利用基于“积极偏差”的概念，对小儿临床途径研究进行创新。拟议的研究之所以重要，是因为预计它将垂直提高和扩大有关实施途径的最佳实践的知识，这将使在第三纪和社区环境中的临床途径增加吸收和成功实施，从而提高了哮喘儿童的基于证据的实践和护理质量。最终，这种新知识可以支持各种儿科疾病的途径实施，以提高护理质量并降低不必要的成本。