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.

项目概要 肝硬化出院患者早期再入院率较高， 这些重新入院对医疗保健系统来说是一个沉重的负担。减少再入院是当务之急 对于医疗保健系统来说，但需要彻底了解可改变的风险因素，从而导致 重新入院。此外，许多重新入院的患者可能会受益于临终关怀转诊， 它在肝硬化患者中未得到充分利用，也可能减少再入院率。这个提议 描述了一个职业发展计划，该计划将使候选人能够发展以患者为中心的专业知识 通过获得卫生服务研究、实施科学、 姑息治疗和生物统计学。具体目标是 (1) 确定以下情况的发生率和预测因素： 肝硬化患者 30 天计划外再入院； (2) 识别与可预防相关的因素 30 天计划外再入院； (3) 制定标准来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 肝硬化住院患者的大型前瞻性队列的特征； (2)系统评估 可预防再入院； (3) 使用修改后的德尔菲共识流程召集专家小组，以 确定临终关怀资格的标准。 拟议的职业发展计划包括： 来自多学科高级团队的密切指导 科学家；卫生服务研究、生物统计学、实施科学等方面的高级课程 定性研究；通过实施拟议的研究计划进行体验式学习；和一个高度 支持性的研究环境。指导团队包括独立调查员 肝病学（Chalasani）临床和转化研究、卫生服务研究和 实施科学（布斯塔尼）、姑息治疗和共识方法（萨克斯）以及观察和 纵向数据分析和生物统计学（高），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 印第安纳临床与转化科学研究所和健康创新中心 实施科学，这将有助于促进候选人的专业成长和职业发展。在 该计划结束后，候选人将有能力成为一名独立医生- 科学家对肝硬化进行高质量的卫生服务研究。

项目成果

A dedicated paracentesis clinic decreases healthcare utilization for serial paracenteses in decompensated cirrhosis.

专门的穿刺诊所减少了失代偿性肝硬化患者连续穿刺的医疗保健利用率。

• 发表时间: 2018
• 作者: Cheng, Yao;Sandrasegaran, Kumar;Cheng, Katherine;Shah, Angela;Ghabril, Marwan;Berry, William;Lammert, Craig;Chalasani, Naga;Orman, Eric S
• 通讯作者: Orman, Eric S

Development and Validation of a Model to Predict Acute Kidney Injury in Hospitalized Patients With Cirrhosis.

预测住院肝硬化患者急性肾损伤的模型的开发和验证。

• 发表时间: 2019
• 作者: Patidar, Kavish R;Xu, Chenjia;Shamseddeen, Hani;Cheng, Yao;Ghabril, Marwan S;Mukthinuthalapati, V V Pavan K;Fricker, Zachary P;Akinyeye, Samuel;Nephew, Lauren D;Desai, Archita P;Anderson, Melissa;El;Chalasani, Naga P;Orman
• 通讯作者: Orman

Palliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important?

失代偿性肝硬化患者的姑息治疗和临终关怀转诊：哪些因素很重要？

• 发表时间: 2020
• 影响因子: 2.8
• 作者: Holden, John H;Shamseddeen, Hani;Johnson, Amy W;Byriel, Benjamin;Subramoney, Kavitha;Cheng, Yao;Saito, Akira;Ghabril, Marwan;Chalasani, Naga;Sachs, Greg A;Orman, Eric S
• 通讯作者: Orman, Eric S

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

一大群肝硬化患者选择性介入内窥镜手术后出血。

• 发表时间: 2020
• 作者: Kundumadam, Shanker;Phatharacharukul, Parkpoom;Reinhart, Kathryn;Yousef, Andrew;Shamseddeen, Hani;Pike, Francis;Patidar, Kavish R;Gromski, Mark;Chalasani, Naga;Orman, Eric S
• 通讯作者: Orman, Eric S

Trends in Characteristics, Mortality, and Other Outcomes of Patients With Newly Diagnosed Cirrhosis.

新诊断肝硬化患者的特征、死亡率和其他结果的趋势。

• 发表时间: 2019
• 影响因子: 13.8
• 作者: Orman, Eric S;Roberts, Anna;Ghabril, Marwan;Nephew, Lauren;Desai, Archita P;Patidar, Kavish;Chalasani, Naga
• 通讯作者: Chalasani, Naga