Unplanned Early Readmissions of Hospitalized Patients with Cirrhosis

住院肝硬化患者的意外提前再入院

• 批准号: 10384144
• 负责人: Eric Orman
• 金额: $ 9.01万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10384144
• 关键词: Active Learning; Ascites; Award; Behavioral; Biometry; Caregiver Burden; Caring; Characteristics; Cirrhosis; Clinical Research; Clinical Sciences; Clinical Trials; Cognitive; Consensus; Data; Data Analyses; Development Plans; Disease; Eligibility Determination; Enrollment; Environment; Extramural Activities; Fostering; Funding; Future; Gastrointestinal Hemorrhage; Goals; Growth and Development function; Health; Health Care Quality Indicators; Health Priorities; Health Services Research; Healthcare Systems; Hepatic Encephalopathy; Hepatology; Hospice Care; Hospitalization; Hospitals; Incidence; Indiana; Infection; Information Networks; Institutes; Intervention; Intervention Studies; Lead; Liver Cirrhosis; Liver diseases; Mentors; Mentorship; Methodology; Methods; Modeling; Outcome; Palliative Care; Patients; Physicians; Population; Positioning Attribute; Process; Prospective cohort; Prospective cohort study; Psychology; Public Health; Qualitative Research; Research; Research Personnel; Resources; Risk Factors; Scientist; Senior Scientist; Severity of illness; Social Work; Specialist; Structure; Translational Research; Transplantation; Transplantation Surgery; Universities; Validation; care outcomes; career; career development; cost; cost estimate; design; effective intervention; end stage disease; follow-up; high risk; high risk population; hospice environment; hospital readmission; implementation science; improved; innovation; liver transplantation; modifiable risk; mortality; multi-component intervention; multidisciplinary; patient oriented; patient oriented research; patient stratification; predictive modeling; programs; prospective; research and development; risk stratification; skills; social factors; time use

PROJECT SUMMARY Patients with liver cirrhosis who are discharged from the hospital have high rates of early hospital readmission, and these readmissions are a significant burden to the health care system. Reducing readmissions is a priority for the health care system, but requires a thorough understanding of modifiable risk factors leading to readmission. In addition, many patients who are readmitted to the hospital may benefit from hospice referral, which is underutilized in patients with cirrhosis, and which may also reduce readmissions. This proposal describes a career development plan that will enable the candidate to develop expertise in patient-oriented clinical research by acquiring the necessary skills in health services research, implementation science, palliative care, and biostatistics. The specific aims are to (1) determine the incidence and predictors of unplanned 30 day readmissions in patients with cirrhosis; (2) identify factors associated with preventable unplanned 30 day readmissions; and (3) develop criteria that identify hospitalized patients with cirrhosis who are suitable for hospice care. To achieve these aims, the candidate will (1) study detailed multidimensional characteristics of a large prospective cohort of hospitalized patients with cirrhosis; (2) systematically assess readmission preventability; and (3) convene an expert panel using the modified Delphi consensus process to identify criteria for hospice eligibility. The proposed career development plan integrates: close mentoring from a multidisciplinary team of senior scientists; advanced coursework in health services research, biostatistics, implementation science, and qualitative research; experiential learning through the conduct of the proposed research plan; and a highly supportive research environment. The mentorship team, which includes independent investigators with expertise in clinical and translational research in hepatology (Chalasani), health services research and implementation science (Boustani), palliative care and consensus methodology (Sachs), and observational and longitudinal data analysis and biostatistics (Gao), will guide the candidate's research and career development. The research environment at Indiana University includes multidisciplinary collaborative organizations such as the Indiana Clinical and Translational Sciences Institute and the Center for Health Innovation and Implementation Science, which will help foster the candidate's professional growth and career development. At the conclusion of this program, the candidate will be well positioned to become an independent physician- scientist conducting high quality health services research in cirrhosis.

项目摘要 从医院出院的肝肝硬化患者的早期医院再入院率很高， 这些再入院是医疗系统的重大负担。减少再入院是当务之急 对于医疗保健系统，但需要对可修改的风险因素有深入的了解，导致 再入院。此外，许多已入院的患者可能会受益于临终关怀转诊， 在肝硬化患者中未充分利用，这也可能减少再入院。这个建议 描述了一项职业发展计划，该计划将使候选人能够发展以患者为导向的专业知识 临床研究通过获得卫生服务研究，实施科学的必要技能， 姑息治疗和生物统计学。具体目的是（1）确定 肝硬化患者计划外30天的再入院； （2）确定与可预防的因素 计划外30天的再入院； （3）制定标准识别住院的肝硬化患者 适合临终关怀。为了实现这些目标，候选人将（1）研究详细的多维 肝硬化患者的大量前瞻性队列的特征； （2）系统评估 可预防性； （3）使用修改后的Delphi共识过程召集专家小组 确定临终关怀资格的标准。 拟议的职业发展计划集成：来自高级学科团队的亲密指导 科学家；卫生服务研究，生物统计学，实施科学和 定性研究；通过拟议的研究计划的进行体验式学习；和一个高度 支持性研究环境。指导团队，其中包括独立调查员 肝病学临床和转化研究专业知识（Chalasani），卫生服务研究和 实施科学（Boustani），姑息治疗和共识方法（SACHS）以及观察性 纵向数据分析和生物统计学（GAO）将指导候选人的研究和职业发展。 印第安纳大学的研究环境包括多学科合作组织，例如 印第安纳州的临床和转化科学研究所以及健康创新中心 实施科学将有助于促进候选人的职业成长和职业发展。在 该计划的结论是，候选人将成为一个独立的医生 - 科学家进行肝硬化的高质量卫生服务研究。

项目成果

Features of Blood Clotting on Thromboelastography in Hospitalized Patients With Cirrhosis.

• DOI: 10.1016/j.amjmed.2020.04.029
• 发表时间: 2020-12
• 期刊: The American journal of medicine
• 作者: Shamseddeen H;Patidar KR;Ghabril M;Desai AP;Nephew L;Kuehl S;Chalasani N;Orman ES
• 通讯作者: Orman ES

Spontaneous Fluctuations in Liver Biochemistries in Patients with Compensated NASH Cirrhosis: Implications for Drug Hepatotoxicity Monitoring.

代偿性 NASH 肝硬化患者肝脏生化的自发波动：对药物肝毒性监测的影响。

• DOI: 10.1007/s40264-019-00896-1
• 发表时间: 2020
• 期刊: Drug safety
• 影响因子: 4.2
• 作者: Shamseddeen,Hani;Vilar-Gomez,Eduardo;Chalasani,Naga;Myers,RobertP;Subramanian,GMani;Shlevin,HaroldH;Allgood,AdamE;Orman,EricS
• 通讯作者: Orman,EricS

Incidence and Risk Factors of Recurrent Clostridioides difficile Infection in Patients With Cirrhosis.

肝硬化患者复发艰难梭菌感染的发病率和危险因素。

• DOI: 10.14309/ctg.0000000000000189
• 发表时间: 2020
• 期刊: Clinical and translational gastroenterology
• 影响因子: 3.6
• 作者: Phatharacharukul,Parkpoom;Purpura,RussellD;Gandhi,Devika;Xu,Huiping;Bickett-Burkhart,Katie;Chalasani,Naga;Fischer,Monika;Orman,EricS
• 通讯作者: Orman,EricS

Improving Outcomes of Bariatric Surgery in Patients With Cirrhosis in the United States: A Nationwide Assessment.

• DOI: 10.14309/ajg.0000000000000911
• 发表时间: 2020-11
• 期刊: The American journal of gastroenterology
• 作者: Are VS;Knapp SM;Banerjee A;Shamseddeen H;Ghabril M;Orman E;Patidar KR;Chalasani N;Desai AP
• 通讯作者: Desai AP

Bleeding After Elective Interventional Endoscopic Procedures in a Large Cohort of Patients With Cirrhosis.

• DOI: 10.14309/ctg.0000000000000288
• 发表时间: 2020-12-17
• 期刊: Clinical and translational gastroenterology
• 影响因子: 3.6
• 作者: Kundumadam S;Phatharacharukul P;Reinhart K;Yousef A;Shamseddeen H;Pike F;Patidar KR;Gromski M;Chalasani N;Orman ES
• 通讯作者: Orman ES