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）：救援失败 (FTR) 的理论和结果测量旨在评估医院对手术患者的护理质量。该提案旨在将 FTR 扩展到医疗状况分析。 FTR 衡量护理人员管理病情复杂的患者并防止其死亡的能力。该措施取决于分析人员区分并发症和合并症的能力以及检测并发症时可用数据的完整性。由于难以区分并发症和合并症，FTR 几乎专门用于外科手术病例。自 1992 年 Silber 首次引入 FTR 度量以来，该度量在外科护理质量评估方面已有许多应用，并且它已成为探索医院特征、护理特征和医生特征重要性的有用度量。 FTR 已获得国家质量论坛多种形式的认可。不幸的是，FTR 指标的好处，无论是在改善严重程度调整还是深入了解医院或提供者在死亡率指标上表现不佳的原因方面，从未成功应用于患有健康状况的患者。然而，自 1992 年首次开发 FTR 以来，分析师可用的数据集发生了根本性的变化。医疗保险索赔数据现在为所有诊断提供“入院就诊”(POA) 指标，这可以极大提高分析师在实施医疗 FTR 分析时区分并发症和合并症的能力。因此，现在有可能开发和验证医疗 FTR 指标。鉴于公众和卫生政策分析师都要求提高质量指标，现在似乎是将该措施扩展到医疗条件的理想时机。该项目有 4 个目标： AIM 1：利用国家医疗保险数据和加利福尼亚州数据，我们将开发和验证主要医疗状况（包括 CHF、AMI 和肺炎）的 FTR 并发症列表。目标 2：使用 AIM 1 的结果，针对每种医疗状况制定医疗 FTR 指标，并研究 FTR 指标的属性。我们将探讨 2 种类型的 FTR 率：使用所有并发症的原始 Silber 定义方法 (FTR) 和使用并发症和死亡子集的 AHRQ 方法 (A-FTR)，我们将比较所有后续假设的结果。目标 3：开发医疗 FTR 和 A-FTR 的严重性调整模型，最后，目标 4：确定医疗 FTR 指标的可靠性和有效性。总之，该提案将建立一种新的方法来检查基于救援失败的医疗状况护理质量。我们的目的是为医学界带来与手术患者并行使用救援失败分析的优势。

项目成果

Failure-to-Rescue After Acute Myocardial Infarction.

急性心肌梗死后抢救失败。

• 发表时间: 2018-05
• 影响因子: 3
• 作者: Silber, Jeffrey H;Arriaga, Alexander F;Niknam, Bijan A;Hill, Alexander S;Ross, Richard N;Romano, Patrick S
• 通讯作者: Romano, Patrick S