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Emergency Medical Services Outcomes Project (EMSOP) II: Developing the foundation and conceptual models for out-of-hospital outcomes research

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 657-663页

作者： Spaite, DW Maio, R Garrison, HG Desmond, JS Gregor, MA Stiell, IG Cayten, CG Chew, JL MacKenzie, EJ Miller, DR O'Malley, PJ Univ Arizona Coll Med Div Emergency Med Arizona Emergency Med Res Ctr Tucson AZ USA Univ Michigan Med Ctr Dept Emergency Med Ann Arbor MI 48109 USA E Carolina Univ Brody Sch Med Dept Emergency Med Greenville NC 27834 USA Univ Ottawa Div Emergency Med Ottawa ON Canada Univ Ottawa Loeb Hlth Res Inst Ottawa ON Canada New York Med Coll Inst Trauma & Emergency Care Valhalla NY 10595 USA EMSSTAR Grp Annapolis MD USA Johns Hopkins Univ Sch Hyg & Publ Hlth Baltimore MD USA Hlth Span Transportat Serv St Paul MN USA Allina Hlth Syst St Paul MN USA Massachusetts Gen Hosp Pediat Emergency Serv Boston MA 02114 USA Massachusetts Dept Publ Hlth Emergency Med Serv Children Boston MA USA

Development of methodologically acceptable outcomes models for emergency medical services (EMS) is long overdue. In this article, the Emergency Medical Services Outcomes Project proposes a conceptual framework that will provide a foundation for future EMS outcomes research. The "Episode of Care Model" and the "Out-of-Hospital Unit of Service Model" are presented. The Episode of Care Model is useful in conditions in which interventions and outcomes, especially survival and major physiologic dysfunction, are linked in a time-dependent manner. Conditions such as severe trauma, anaphylaxis, airway obstruction, respiratory arrest, and nontraumatic cardiac arrest are amenable to this methodology. The Out-of-Hospital Unit of Service Model is essentially a subunit of the Episode of Care Model. it is valuable for evaluating conditions that have minimal-to-moderate therapeutic time dependency. This model should be used when studying outcomes limited to the out-of-hospital interval. An example of this is pain management for injuries sustained in motor vehicle crashes. These models can be applied to a wide spectrum of conditions and interventions. With the scrutiny of health care expenditures ever increasing, the identification of clinical interventions that objectively improve patient outcome takes on growing importance. Therefore, the development, dissemination, and use of meaningful methodologies for EMS outcomes research is key to the future of EMS system development and maintenance.

关键词：出院后医疗/组织和管理急救医疗服务/组织和管理治疗过程片断卫生工作重点卫生服务研究/组织和管理模型组织管理年患病率结果评价(卫生保健)/组织和管理规划制订/方法研究设计/标准风险调节/组织和管理存活率分析时间因素美国/流行病学人类

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Research Priorities Project, year 2000: Establishing a direction for infection control and hospital epidemiology

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第2期29卷 73-78页

作者： Lynch, P Jackson, M Saint, S Epidemiol Associates Seattle WA USA Univ Calif San Diego Med Ctr Dept Educ Dev & Res San Diego CA 92103 USA Univ Michigan Sch Med Ann Arbor MI USA

Background: The field called "infection control" has expanded beyond hospitals to include many health care locations, some aspects of personnel health, elements of noninfectious complications, and occasionally the epidemiology of other problems that occur in care facilities. A research agenda that addresses these newer segments and provides a framework for answering fundamental questions is essential for the field and for the work of The Research Foundation for Prevention of Complications Associated with Health Care (formerly APIC Research Foundation). Methods: We used a multiple-round iterative consensus process (Delphi technique) with 50 experts and a validation round among participants at the 4th Decennial Conference. Results: The expert panel reduced 102 separate items to 21 high-ranked research priorities. The highest-ranked subject areas involved research to improve compliance 4 with excellent practices, to study antibiotic usage and resistance, to measure the financial impact of complications and value of interventions, to perform surveillance of infectious and noninfectious complications across the spectrum of care delivery, and to study effectiveness of interventions to prevent complications at specific sites. There were differences in education and discipline between the expert panel and the 4th Decennial participants and with respect to ranking some of the individual priorities Among respondents from outside the United States and Canada, occupational health issues were ranked more highly. Conclusions: The research priorities provide a blueprint for future progress and will require a collaborative, multicenter, multinational approach.

关键词：医务工作者的态度费用效益分析德尔菲技术流行病学/组织和管理预测基金会/组织和管理卫生工作重点卫生服务研究/组织和管理感染控制/组织和管理需求估价/组织和管理组织目标研究设计全面质量管理/组织和管理成年人老年人人类中年人

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Introduction: Community action research and the prevention of alcohol problems at the local level

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SUBSTANCE USE & MISUSE 2000年第1-2期35卷 1-10页

作者： Allamani, A Casswell, S Graham, K Holder, HD Holmila, M Larsson, S Nygaard, P Florence Hlth Agcy Alcohol Ctr Florence Italy Univ Auckland Alcohol & Publ Hlth Res Unit Auckland New Zealand Addict Res Fdn London England Prevent Res Ctr Berkeley CA USA STAKES Social Res Unit Alcohol Studies Helsinki Finland Univ Lund Malmo Sweden Aarhus Univ Ctr Alcohol & Drug Res Aarhus Denmark

Many community action projects from around the world exist to reduce alcohol problems at the local level. The role of research within this international movement is discussed within this introduction for the entire special issue on community action research in alcohol problem prevention. Previous community prevention programs have utilized a variety of prevention strategies: (a) an educational approach which focuses on changing behavior through changes in knowledge, attitudes, and information;and (b) an environmental approach which focuses on changing behavior through changes in the social and economic systems within a community. Many projects have used both approaches. This special issue provides a current overview of many types of community action projects from different countries and summarizes what has been learned to date from these experiences.

关键词：酒精中毒/预防和控制用户参与/方法健康教育/组织和管理健康知识态度实践卫生服务研究/组织和管理组织目标社会环境人类

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Health education in Africa: 1975-2000

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HEALTH EDUCATION RESEARCH 2000年第4期15卷 383-391页

作者： Brieger, WR Adeniyi, JD Parker, KA Oladepo, O Univ Ibadan Coll Med African Reg Hlth Educ Ctr Ibadan Nigeria Univ Ibadan Coll Med African Reg Hlth Educ Ctr Ibadan Nigeria

The past 25 years of health education in Africa has experienced the growth of indigenous health education service, training and research programmes and activities. Research in Africa and by Africans has provided a bas... 详细信息

关键词：非洲健康教育/组织和管理健康教育/发展趋势卫生人员/教育卫生服务研究/组织和管理在职培训/组织和管理

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Midwifery care research: What questions are being asked? What lessons have been learned?

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JOURNAL OF MIDWIFERY & WOMENS HEALTH 2000年第1期45卷 20-36页

作者： Raisler, J Columbia Univ Nurse Midwifery Educ Program New York NY 10027 USA

Purpose: To create and critically evaluate a research database about midwifery care that identifies topics studied, research methods, results, funding, publication data, and implications for a future midwifery research agenda. Methods: Systematic literature review. Studies included were 1) data-based research;2) about midwifery care or practice;3) in the United States;and 4) published between 1984-1998. nle CINAHL and MEDLINE electronic databases were searched using a defined strategy, and relevant journals and bibliographies were searched by hand. Results: This 15-year review identified 140 studies of midwifery care published in 161 papers. A midwife was the lead author on 60%. Sixty percent were published in the Journal of Nurse-Midwifery. Six to 15 studies were published each year, and both the number of publications and funding increased over the time period. The six major areas of focus were: 1) midwifery management, 2) structure of care, 3) midwifery practice, 4) midwife-physician comparisons, 5) place of birth, and 6) care of vulnerable populations. Discussion: Although retrospective descriptive studies still predominate, more prospective studies, randomized controlled trials, multi-site studies, and quasi-experimental designs are being conducted. Qualitative methods are helping to measure nontraditional outcomes. A research agenda should be established based on discussion and debate within the profession. Midwife investigators need to build research teams and collaborate with other disciplines. Key areas for future research include alternative therapies, breastfeeding, cost-effectiveness, cultural studies, gynecology, health policy, menopause, post partum care, substance abuse interventions, and the woman's experience of birth and midwifery care. (C) 2000 by the American College of Nurse-Midwives.

关键词：数据收集卫生服务研究/组织和管理卫生服务研究/发展趋势助产学研究设计女(雌)性人类妊娠

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Organisational research methods: closing the gap

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LANCET 2000年第9197期355卷 71-71页

作者： Morrison, B Lilford, RJ Univ Birmingham Sch Med Dept Epidemiol & Publ Hlth Birmingham B15 2TT W Midlands England

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Shifting services from secondary to primary care: Stakeholders' views of the barriers

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Journal of Health Services Research and Policy 1999年第3期4卷 154-160页

作者： Musson, G. Munro, J. Medical Care Research Unit School Health and Related Research University of Sheffield Sheffield S1 4DA Regent Court 30 Regent Street United Kingdom

Objectives: To identify the barriers to shifting services from secondary to primary care perceived by the involved stakeholders. Methods: Forty-five semi-structured interviews with stakeholders from primary care, acute and community hospitals, purchasers (health authorities) and other agencies involved in two contrasting initiatives to shift services. Results: Stakeholders perceived similar barriers in the two initiatives: disinvesting from existing providers;lack of information on activity and costs;uncertainty over the quality of the proposed alternative service;concern about an increasing workload in primary care;diversity of views within primary care;difficulties in communication between the many agencies involved;and lack of leadership by purchasers. Conclusions: Service shifts which involve disinvestment from existing providers and collaboration between agencies with different views and interests will inevitably face a range of barriers. Attempts to shift services by disinvesting from secondary care are likely to encounter the greatest difficulties. Attempts to shift without concomitant disinvestment may also be slow because of the difficulties of multi-agency collaboration. Frustration will be reduced if those involved have a realistic understanding of the difficulties rather than being surprised and overwhelmed by them.

关键词：医务工作者的态度预算效率组织家庭医学/统计学和数值数据大不列颠卫生服务研究/组织和管理医院社区/经济学医院社区/利用投资领导组织改革初级卫生保健/经济学初级卫生保健/利用工作负荷量

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Population-based linkage of health records in Western Australia: development of a health services research linked database

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第5期23卷 453-459页

作者： Holman, CDJ Bass, AJ Rouse, IL Hobbs, MST Univ Western Australia Dept Publ Hlth Ctr Hlth Serv Res Nedlands WA 6907 Australia Univ Western Australia Dept Publ Hlth Unit Clin Epidemiol Nedlands WA 6009 Australia

Objectives: To introduce the Western Australian Health Services Research Linked Database as infrastructure to support aetiologic, utilisation and outcomes research. To compare the study population, data resources, technical systems and organisational supports with international best practice in record linkage and health research. Method and Results: The WA Linked Database systematically links the available administrative health data within an Australian State of 1.7 million people. It brings together, initially, six core data elements (birth records, midwives' notifications, cancer registrations, inpatient hospital morbidity, in-patient and public out-patient mental health services data and death records). It will be updated regularly and is designed, in future extensions, to include data on primary, residential and domiciliary care and health surveys. Linkage uses probabilistic matching of patient names and other identifiers. Geocodes for spatial analysis are assigned using address linkage and mapping software. By June 1997, the project had taken 2 1/2 years to develop the system and link seven million core data records from 1980 to 1995. Conclusions: The system is consistent with international benchmarks, from four centres of excellence, for the study population, core datasets, matching and geocoding, and collaborative networks. There are prospects to redress deficiencies in primary medical contact and other data resources, validation studies, tracing systems and a more supportive legal framework. Implications: The WA Linked Database will be used in combination with medical record audits to provide a comprehensive evaluation of health system performance.