Determinants, Outcomes, and Financial Incentives Associated with Cardiac Rehabilitation Enrollment After Cardiac Surgery

与心脏手术后心脏康复入组相关的决定因素、结果和经济激励

• 批准号: 10299796
• 负责人: Michael Patrick Thompson
• 金额: $ 13.94万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10299796
• 关键词: Determinants; Outcomes; Financial; Incentives; Associated

PROJECT SUMMARY/ABSTRACT CANDIDATE: Michael P. Thompson, PhD, is an epidemiologist, health services researcher, and faculty member in the Department of Cardiac Surgery at the University of Michigan. His long-term career goal is to conduct impactful, significant, and innovative research that improves the value of cardiac surgery. The proposed K01 award application includes a 5-year plan for career development and research activities needed to achieve this career goal and become a successful independent investigator. BACKGROUND: Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention that improves outcomes, but has not been widely adopted. Among cardiac surgical patients, clinical trials have demonstrated that CR extends life, improves cardiovascular function and quality of life, and prevents downstream health care utilization. Despite this evidence, half of cardiac surgical patients never attend a single session of CR, and only one-third of CR enrollees finish the entire 36 recommended sessions. Disparities in CR enrollment across have also been demonstrated across patients, providers, and geographic regions. Improving CR enrollment is critical to ensuring its full potential for cardiac surgical patients. RESEARCH AIMS: My long-term goal is to improve the value of cardiac surgical care. The aims of this study are: (1) to identify determinants of CR enrollment after cardiac surgery, (2) to measure the effect of CR enrollment after cardiac surgery on clinical and economic outcomes, and (3) to estimate the impact of financial incentives on CR enrollment after cardiac surgery. In order to achieve these objectives, we propose a series of quantitative analyses on a unique combination of claims data and clinical data from the IMPROVE Network, which shares data and best practices across five multicenter cardiovascular quality collaboratives covering over 90 hospitals in 9 states (~10% of all US cardiac surgical programs). TRAINING AIMS: Three training aims have been proposed to facilitate the proposal. (1) To gain a deeper understanding of cardiac surgical care delivery. (2) To gain causal inference skills with in-depth comparative effectiveness and policy evaluation components. (3) To develop skills and experience in implementation science methods. IMPACT: Findings from this proposal will provide evidence needed to develop the necessary evidence to appropriately expand and incentivize CR enrollment after cardiac surgery, which will increase the value of cardiac surgical care. The proposal is directly responsive to AHRQ’s interest in (i) generating evidence that will increase the affordability, efficiency, and quality of health and (ii) health services research to achieve a high- value healthcare system. Above all, the proposed research strategy, career development plan, mentorship, and institutional environment will cultivate my growth into an independent health services researcher.

项目摘要/摘要 候选人：迈克尔·汤普森（Michael P. 密歇根大学心脏外科系的成员。他的长期职业目标是 进行有影响力的，重要和创新的研究，以提高心脏手术的价值。这 拟议的K01奖励申请包括一项为期5年的职业发展和所需研究活动的计划 为了实现这一职业目标并成为成功的独立调查员。 背景：心脏康复（CR）是一种多学科的，基于证据的干预措施，可改善 结果，但尚未被广泛采用。在心脏外科患者中，临床试验已证明 CR可以延长生命，改善心血管功能和生活质量，并防止下游医疗保健 利用率。尽管有证据表明，一半的心脏外科患者从未参加过一次CR，只有 CR注册的三分之一完成了整个建议的会议。 CR入学的差异 在患者，提供者和地理区域之间也证明了这一点。改善CR入学是 确保其对心脏手术患者的全部潜力至关重要。 研究目的：我的长期目标是提高心脏手术护理的价值。这项研究的目的 为：（1）识别心脏手术后CR入学的确定剂，（2）测量CR的影响 心脏手术后的临床和经济成果进行入学，（3）估计金融的影响 心脏手术后CR入学的激励措施。为了实现这些目标，我们提出了一系列 从改善网络中的索赔数据和临床数据的独特组合进行定量分析， 它在五个多中心心血管质量合作社中共享数据和最佳实践 9个州的90多家医院（约占美国心脏手术计划的10％）。 培训目的：已经提出了三个培训目标来促进该提议。 （1）更深入 了解心脏手术护理。 （2）以深入比较获得因果推理技能 有效性和政策评估组件。 （3）发展实施技能和经验 科学方法。 影响：该提案的调查结果将为建立必要证据提供所需的证据 心脏手术后适当扩展和增加CR入学率，这将增加 心脏手术护理。该提案直接响应AHRQ对（i）产生证据的兴趣 提高健康的可用性，效率和质量以及（ii）健康服务研究，以实现高 价值医疗保健系统。最重要的是，拟议的研究策略，职业发展计划，指导职位， 机构环境将使我的成长培养为独立的卫生服务研究人员。