Functional, Cognitive, and Social Vulnerabilities and Hospital Readmission

功能、认知和社交脆弱性以及再入院

基本信息

批准号：
8874821
负责人：
Scott Ryan Greysen
金额：
$ 16.01万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-15 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8874821
关键词：
Acute Address Adult Adverse drug event Affect Aging Area Attention Biometry California Caregivers Caring Cities Cognitive Data Data Analyses Data Collection Data Set Data Sources Diet Elderly Epidemiologic Studies Event Faculty Future Geriatrics Goals Health Health Care Reform Health Policy Healthcare Healthcare Systems Heart failure Hospitalists Hospitalization Hospitals Impaired cognition Influentials Inpatients Intervention Intervention Studies Interview K-Series Research Career Programs Lead Leadership Link Literature Measures Medicare Medicare claim Mentored Patient-Oriented Research Career Development Award Mentors Myocardial Infarction Outcome Outcomes Research Patient Discharge Patients Pharmaceutical Preparations Pneumonia Policies Policy Research Population Process Qualitative Methods Quality of Care Recovery Research Research Methodology Research Personnel Resources Retirement Risk Assessment Risk Factors San Francisco Social Impacts Social support Subgroup Surveys Techniques Testing Time Universities base cohort cost data modeling design disability evidence base experience high risk hospital analysis hospital readmission implementation science improved multidisciplinary older patient patient oriented predictive modeling social social health determinants

项目摘要

DESCRIPTION (provided by applicant): This career development award will establish Dr. Ryan Greysen, a hospitalist at the University of California, San Francisco as a clinician-investigator focused on core geriatric vulnerabilities (functional, cognitive, and social) that impact hospital outcomes among older adults. This K23 award will provide Dr. Greysen the support needed to accomplish 4 goals: (1) to become an expert patient-oriented outcomes researcher in aging research; (2) to elucidate risk factors for readmission among vulnerable older adults and understand the mechanisms by which these factors directly impact patients/caregivers; (3) to develop expertise in mixed methods research through use of advanced quantitative and qualitative techniques (4) to develop leadership in health policy at the intersection of hospital medicine and geriatrics. To achieve these goals, Dr. Greysen has assembled an expert multidisciplinary team in geriatrics, quantitative and qualitative methods, and health policy research. His primary mentor, Dr. Kenneth Covinsky, has extensive experience in aging outcomes research and mentoring junior faculty to become independent investigators in aging research. His co-mentors are Dr. Andrew Auerbach, an expert in quantitative analysis of hospital quality of care and implementation science, and Dr. Daniel Dohan, a leading expert in qualitative analysis of social determinants of health and health policy. Dr. Greysen will also benefit from the expertise of two distinguished scientific advisors with expertise in advanced biostatistics and mixed methods research. Hospital readmission is a common, costly, and important event in the health trajectory of older adults. Dr. Greysen's research plan builds on his preliminary data to examine the impact of functional, cognitive, and social vulnerabilities on readmission for Medicare patients. He will study these effects by adding data about these vulnerabilities from the nationally-representative Health and Retirement Survey (HRS) to Medicare claims data and modeling the same analytical approach used by Medicare to penalize hospitals for higher than expected rates of 30-day readmission (Aim1a-c). To maximize the immediate policy impact of this research, Dr. Greysen will also conduct a subgroup analysis of patients admitted with heart failure, heart attack, or pneumonia to mirror the initial implementation of this controversial Medicare policy in 2012 (Aim 1d). Dr. Greysen will also conduct in-depth qualitative data collection and analysis with hospitalized older adults with functional, cognitive, and social vulnerabilities recently discharged from two hospitals (one large public and one large academic hospital) in one city (Aim 2). This aim will explore mechanisms by which vulnerability directly impacts efforts of older adults and caregivers to recuperate from hospitalization and enable future interventions targeting these patients. This research plan leverages existing UCSF and NIA resources of Dr. Covinsky's geriatric outcomes research group and the HRS-Medicare dataset. Finally, this research will form the basis for an R01 application to study interventions to improve outcomes of transition care for hospitalized older adults.

描述（由申请人提供）：该职业发展奖将建立加利福尼亚大学旧金山分校的住院医生瑞安·格雷森（Ryan Greysen）博士，是一名临床医生评估者，重点是核心老年脆弱性（功能，认知和社会），影响老年人的医院企业。该K23奖将为Greysen博士提供实现4个目标所需的支持：（1）成为衰老研究的专家成果研究者；（2）阐明弱势老年人重新入院的风险因素，并了解这些因素直接影响患者/看护者的机制；（3）通过使用先进的定量和定性技术（4）来发展混合方法研究中的专业知识（4）在医院医学和老年医学的交集中发展卫生政策的领导力。为了实现这些目标，Greysen博士召集了一支专业的多学科团队，领域的老年医学，定量和定性方法以及健康政策研究。他的主要导师肯尼斯·科文斯基（Kenneth Covinsky）博士在衰老的结果研究和指导初级教师方面拥有丰富的经验，成为衰老研究的独立研究人员。他的联合给出者是安德鲁·奥尔巴赫（Andrew Auerbach）博士，他是医院护理和实施科学质量分析的专家，以及对健康和卫生政策社会决定因素的定性分析的主要专家丹尼尔·多恩（Daniel Dohan）博士。 Greysen博士还将受益于两位具有高级生物统计学和混合方法研究专业知识的杰出科学顾问的专业知识。在老年人的健康轨迹中，医院再入院是一个普遍，昂贵且重要的事件。 Greysen博士的研究计划以他的初步数据为基础，以研究功能，认知和社会脆弱性对Medicare患者再入院的影响。他将通过添加有关这些漏洞的数据来研究这些效果，从全国代表性的健康和退休调查（HRS）到Medicare索赔数据，并建模Medicare使用的分析方法对医院的相同分析方法对医院的惩罚，以高于预期的30天重新入院率（AIM1A-C）。为了最大程度地提高这项研究的政策影响，Greysen博士还将对患有心力衰竭，心脏病发作或肺炎的患者进行亚组分析，以反映2012年这种有争议的Medicare政策的最初实施（AIM 1D）。 Greysen Will博士同时，最近从两家医院出院的具有功能性，认知和社会脆弱性的住院老年人（一家大型医院）（一名大型医院）进行了深入的定性数据收集和分析一个城市的公共和一家大型学术医院）（AIM 2）。该目标将探索脆弱性直接影响老年人和护理人员恢复住院的努力的机制，并实现针对这些患者的未来干预措施。该研究计划利用了科文斯基博士的老年人结果研究小组和HRS-Medicare数据集的现有UCSF和NIA资源。最后，这项研究将构成R01应用于研究干预措施以改善住院老年人过渡护理的结果的基础。