Medical Failure-to-Rescue

医疗抢救失败

• 批准号: 9142287
• 负责人: JEFFREY H SILBER
• 金额: $ 24.78万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2018-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9142287
• 关键词: Medical; Failure; Rescue

DESCRIPTION (provided by applicant): The theory and outcome measure Failure-to-Rescue (FTR) was developed to assess hospital quality of care for surgical patients. This proposal seeks to extend FTR to the analysis of medical conditions. FTR measures the ability of caregivers to manage a patient who becomes complicated and keep them from dying. The measure depends on the ability of the analyst to differentiate complications from comorbidities and on the completeness of the available data in detecting complications. Due to difficulties in distinguishing complications from comorbidities, FTR has been applied almost exclusively to surgical cases. Since the metric FTR was first introduced by Silber in 1992, there have been many applications of the metric for quality assessment of surgical care, and it has been a useful metric for exploring the importance of hospital characteristics, nursing characteristics, and physician characteristics. FTR has been endorsed in multiple forms by the National Quality Forum. Unfortunately, the benefits of the FTR metric, both with respect to improving severity adjustment and gaining insight into why a hospital or provider may be performing poorly on mortality metrics, have never been successfully applied to patients with medical conditions. However, there has been a radical change in the data sets available to analysts since 1992 when FTR was first developed. Medicare claims data now provide a "present on admission" (POA) indicator for all diagnoses, which could greatly improve the ability of analysts to distinguish complications from comorbidities when implementing a medical FTR analysis. Therefore, it is now possible to potentially develop and validate a medical FTR metric. Given the demand for improved quality metrics by both the public and health policy analysts alike, it would seem like an ideal time to extend the measure to medical conditions. This project has 4 aims: AIM 1: Using national Medicare data and state data from California, we will develop and validate a list of FTR complications for major medical conditions including CHF, AMI, and Pneumonia. AIM 2: Using results from AIM 1, develop a medical FTR metric for each medical condition and study the properties of the FTR metric. We will explore 2 types of FTR rates: The original Silber defined approach (FTR) using all complications and the AHRQ approach (A-FTR) using a subset of complications and deaths, and we will compare results for all subsequent hypotheses. AIM 3: Develop a severity adjustment model for medical FTR and A-FTR, and finally, AIM 4: Determine the reliability and validity of the medical FTR metric. In summary, this proposal will establish a new approach to examining quality of care for medical conditions based on Failure-to-Rescue. Our intent is to bring to the medical community the advantages of using a failure-to-rescue analysis in a parallel manner to surgical patients.

描述（由申请人提供）：开发了理论和结果措施失败（FTR），以评估外科患者的医院护理质量。该建议旨在将FTR扩展到对医疗状况的分析。 FTR衡量护理人员管理变得复杂并防止他们死亡的患者的能力。该度量取决于分析师区分并发症与合并症的能力以及检测并发症的可用数据的完整性。由于将并发症与合并症区分开来，FTR几乎完全应用于手术病例。自从Silber于1992年首次引入了公制FTR以来，该指标有许多用于手术护理质量评估的指标，并且对于探索医院特征，护理特征和医师特征的重要性是一个有用的指标。 FTR已由国家质量论坛以多种形式认可。不幸的是，在改善严重程度调整以及对为什么医院或提供者在死亡率指标上的表现较差的原因，FTR指标的好处从未成功地应用于患有医疗状况的患者。但是，自1992年FTR首次开发时，分析师可用的数据集发生了根本性的变化。 Medicare索赔数据现在为所有诊断提供了“入院”（POA）指标，这可以大大提高分析师在实施医学FTR分析时将并发症与合并症区分开的能力。因此，现在有可能有可能开发和验证医疗FTR度量。鉴于公共和卫生政策分析师对质量指标的提高需求，这似乎是将措施扩展到医疗状况的理想时机。该项目有4个目标：目标1：使用加利福尼亚州的国家医疗保险数据和州数据，我们将开发并验证包括CHF，AMI和肺炎在内的主要医疗状况的FTR并发症清单。 AIM 2：使用AIM 1的结果，为每种医疗状况开发一个医学FTR度量，并研究FTR度量的特性。我们将使用所有并发症和AHRQ方法（A-FTR）探索2种类型的FTR速率：使用并发症和死亡的子集，我们将比较所有后续假设的结果。目标3：为医学FTR和A-FTR开发严重性调整模型，最后，AIM 4：确定医疗FTR度量的可靠性和有效性。总而言之，该提案将建立一种新的方法来检查基于失败的医疗状况的护理质量。我们的目的是将以并行方式使用失败救援分析的优势带给医学界。