Improving the value (maximized quality and outcomes for each dollar spent) of emergency care for children is critical for public health and the U.S. healthcare system. To improve the emergency care of children, national and state programs have sought to increase the “pediatric readiness” of emergency services. However, the evidence to inform such programs and characterize a high-value emergency care system for injured children is sparse.
A Multi-State Evaluation of ED Pediatric Readiness: Guideline Uptake & Association with Quality, Outcomes, & Cost
This grant is funded by HRSA through the EMS Targeted Issues Grant Program - Grant #H34MC33243.
This project will critically evaluate the impact of national health policy on the emergency care of children over an 8-year period, including ways to further optimize survival and quality, with attention to costs. We are performing a multi-state evaluation of pediatric readiness, outcomes, quality, and costs based on children seeking emergency care.
We will use three cohorts: (1) injured children presenting to 1,504 EDs in 13 states; (2) children with medical conditions presenting to the same EDs in 13 states; and (3) pediatric trauma patients admitted to 639 trauma centers in 44 states. We will include children 0–17 receiving ED care from 1/1/2019-12/31/2020 compared to identical cohorts enrolled from 1/12012-12/312014. Each of these time periods will be aligned with data from two national pediatric readiness surveys (2012-2013 and 2020) and data from the American Hospital Association national survey. The cohorts will include approximately 13.6 million injured children, 36.4 million children with medical conditions, and 389,565 pediatric trauma patients. Outcomes will include: mortality (in-hospital, 30-day, and 1-year); preventable complications (quality measures); and costs (hospital- and patient-level).
Goals and Objectives: The proposal has three objectives:
Objective 1: Quantify ED adoption of the pediatric readiness guidelines over an 8 year period and the resulting association with health outcomes and quality of care among children presenting to 1,504 EDs in 13 states and (separately) 639 U.S. trauma centers.
Objective 2. Estimate the additional gains in health outcomes and quality by shifting the location of emergency care to high-readiness EDs within 30 minutes of home among high-risk children presenting to 1,504 EDs in 13 states and 639 U.S. trauma centers.
Objective 3: Measure the hospital costs of reaching a given level of pediatric readiness (148 EDs in 16 states) and the adjusted patient costs of care among EDs with different levels of readiness (1,504 EDs in 13 states).
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The Value of Pediatric Readiness for the Emergency Care of Children
This grant is funded by the NIH NICHD, Grant #5R24HD085927
For this project we will build a 12-state cohort of children, with particular focus on injured children, to describe deficits in the current emergency care system; test the associations between pediatric readiness, quality, outcomes and cost; and use decision analysis to identify an optimal system for quality and outcomes in a cost-constrained environment.
Unintentional injury remains the leading cause of death and years of potential life lost in children. The use of emergency services following injury is common, with large variability in the readiness of EDs and hospitals to care for injured children. While several national and state efforts have sought to improve pediatric readiness, it remains unclear whether increased readiness improves quality and health outcomes in children, and at what cost. This project seeks to use population science and big biomedical data to create a 12-state cohort of children and to use this cohort and an interdisciplinary team to rigorously evaluate the emergency care system for children in terms of quality, outcomes, and costs. We will build a dataset of all children seeking emergency care, with a particular focus on injured children. This project will fill key scientific gaps in pediatric trauma care and seeks to identify a re-engineered, high-value emergency care system for injured children that optimizes quality, outcomes and costs.
Objectives: The proposal has 3 specific aims:
Specific Aim 1. Describe and quantify the emergency care of injured children across 12 states in the context of pediatric readiness, including out-of-hospital care, ED care, inpatient care and 12-month mortality.
Specific Aim 2. To evaluate the independent associations between pediatric readiness and quality of care, health outcomes and costs among injured children, including changes over time.
Specific Aim 3. Use decision analysis to assess the balance of quality, outcomes and costs (“value”) for pediatric readiness in the emergency care of injured children, including whether the value changes over time.
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Pediatric Readiness Writing Groups
Currently, research proposals are being accepted only from Investigators that are part of these project teams. Pediatric Readiness Investigators who are interested in proposing an idea, collaborate or lead a manuscript writing group, may express their interest by following the process outlined below.
Interested in proposing an idea?
2. Review: Current Dataset(s) and Variables Available to Investigators (5/8/20 - currently in development)
3. Submit your proposal - Manuscript Proposal Form
Writing groups: There are currently 3 proposed manuscript projects in development utilizing the NTDB data. Writing groups have not yet been formed for any of these papers. As these project develop we will update the Writing Groups & Manuscripts webpage.
Please direct questions, or to express interest in joining a writing group when formed, please contact Jenny Cook