The Value of Emergency Care For Injured Older Adults

紧急护理对受伤老年人的价值

• 批准号: 9061561
• 负责人: Craig D. Newgard
• 金额: $ 24.45万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9061561
• 关键词: Value; Emergency; Care; Injured; Older

 DESCRIPTION (provided by applicant): We will build on a previously collected prospective cohort of injured older adults accessing 911 emergency medical services (EMS) in 7 counties by matching to pre-/post-injury Medicare data, state trauma registries, state discharge data and end-of-life preferences. We will then evaluate the value of emergency care for injured older patients using long-term outcomes, resource use and costs. Importance: Current EMS triage practices fail to identify many older adults with serious injuries, resulting in transport to non-trauma hospitals (under-triage) and potentially worse outcomes. Under-triage is counter- balanced by over-triage (transport of patients with minor injuries to major trauma centers), which results in unnecessary costs, disruptions in care and no measureable benefit. However, there is little research to describe and understand these issues, particularly in older adults. This project will rigorously address EMS triage practices unique to older adults, including the role of comorbidities, medication use, end-of-life preferences, functional survival, resource use and costs. We will also validate new triage guidelines to better identify seriously injured older adult and compare to current triage practices. This project will fill key scientific gaps and inform the next revision of national EMS triage guidelines. Objectives: The proposal has 3 specific aims: Specific Aim 1. Describe the current emergency care system for injured older adults, including out-of-hospital triage processes, reasons for selecting hospitals, short- and long-term outcomes, resource use, and costs. Specific Aim 2. Refine and validate a previously derived out-of-hospital risk stratification tool to better identify seriously injured older adults that could be incorporatd into national triage guidelines. Specific Aim 3. Estimate the overall programmatic impact (benefits, harms and costs) of triage guidelines from Aim 2, compared to current triage guidelines. Study Design: This will be a secondary analysis of a 7-county, population-based, prospective EMS cohort, matched to pre- and post-injury Medicare data, two state trauma registries, two state discharge databases and the Oregon Physician Orders for Life-Sustaining Treatment (POLST) registry. Setting: The setting includes 7 counties in Oregon and Washington (urban, suburban and rural regions), 44 EMS agencies and 44 acute care hospitals (4 major trauma centers and 40 non-tertiary hospitals). Participants: The study will include 17,909 injured adults = 65 years transported by EMS to 44 hospitals between 1/1/2011 - 12/31/2011, representing the denominator of older adults to whom the field triage guidelines are applied. Patients with serious injuries (Injury Severity Score = 16) will define high-risk patients. Outcome measures: Outcomes will include 1-year functional survival, resource use (repeat EMS transports, repeat ED visits and re-admissions), and health care costs up to 1-year post-injury.

 描述（由适用提供）：我们将建立在先前收集的预期的受伤的老年人队列的基础上，通过匹配7县的911紧急医疗服务（EMS），通过与受伤前/后/后的医疗保险数据，州创伤注册，州出院数据和寿命终止偏好相匹配。然后，我们将使用长期结果，资源使用和成本评估受伤老年患者的紧急护理价值。重要性：当前的EMS分类实践未能识别出许多严重受伤的老年人，导致非创伤医院（障碍）和可能的结果更糟。通过过度交易（对重大创伤中心轻伤的患者运输）的竞争不足，这会导致不必要的成本，护理中断和没有可衡量的福利。但是，几乎没有研究来描述和理解这些问题，尤其是在老年人中。这个项目 我们还将验证新的分类指南，以更好地识别严重受伤的老年人，并与当前的分类习惯相比。该项目将填补关键的科学空白，并为国家EMS Triage指南的下一次修订提供信息。目标：该提案具有3个特定目的：特定目标1。描述当前针对受伤老年人的急诊系统，包括院外分类过程，选择医院的原因，短期和长期成果，资源使用和成本。具体目的2。完善并验证先前衍生的院外风险分层工具，以更好地识别可将其纳入国家分类指南中的严重受伤的老年人。特定目标3。与当前的分类指南相比，AIM 2的三角形指南的总体程序影响（收益，危害和成本）的总体程序影响（福利，危害和成本）。研究设计：这将是对7个县，基于人群的前瞻性EMS队列的次要分析，与受伤前和后的医疗保险数据相匹配，两个国家创伤注册表，两个州出院数据库和俄勒冈州的医生订单，用于生命维持治疗（POLST）。设置：该环境包括俄勒冈州和华盛顿（城市，郊区和农村地区），44家EMS机构和44家急诊医院（4家主要创伤中心和40家40家非第三期医院）的7个国家。参与者：这项研究将包括17,909名受伤成年人= 65岁，由EMS运送到1/1/11/2011-12/31/2011之间，代表了将现场分类指南应用的老年人的分母。严重受伤（损伤严重程度得分= 16）的患者将定义高危患者。结果 措施：结果将包括1年的功能生存，资源使用（重复EMS运输，重复访问和重新入学）以及最高伤害后1年的医疗保健费用。