Explaining Rising Heart Failure Mortality in Medicare

解释医疗保险中不断上升的心力衰竭死亡率

基本信息

批准号：
9977244
负责人：
Rishi Kumar Wadhera
金额：
$ 17.25万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-15 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9977244
关键词：
Accident and Emergency department Advisory Committees Affect Age Area Automobile Driving Award Awareness Biostatistical Methods Cardiovascular system Caring Clinical Clinical Investigator Complex Data Decision Making Elderly Emergency department visit Financial Hardship Foundations Goals Health Policy Heart failure Hospitalization Hospitals Incentives Individual Inpatients Interview Length of Stay Low income Medicare Medicare claim Medicine Mentors Neighborhoods Outcome Outcomes Research Outpatients Patient Care Patient Preferences Patient Triage Patient-Focused Outcomes Patients Patterns of Care Perception Physicians Policies Population Poverty Prevalence Program Development Public Health Qualitative Methods Quality of Care Reporting Research Research Personnel Resources Risk Risk Factors Site Social Change Structure Surveys Testing Time United States Vulnerable Populations Work acute care base beneficiary care delivery care outcomes career career development clinical care deprivation design disadvantaged population experience federal policy financial incentive follow-up high risk hospital readmission improved improved outcome innovation insight large datasets mortality novel strategies older patient policy implication pressure profiles in patients programs readmission rates residence skills social social disadvantage social vulnerability trend

项目摘要

! ! PROJECT(SUMMARY/ABSTRACT( The clinical and financial burden of heart failure (HF) among older adults in the United States is high, with over 400,000 hospitalizations and $30 billion in spending annually. After a decade of steady improvement in short- term mortality among older adults hospitalized with HF, mortality within 30 days of hospital discharge is now increasing in this population. Little is known, however, about the factors driving this concerning trend. This study proposes to use administrative and qualitative data to evaluate patient, hospital, and policy level factors that explain rising mortality. In Aim 1, we will use Medicare data to determine if increasing clinical and/or social risk among older adults hospitalized with HF, or worsening hospital care quality, explain recent trends in mortality. In Aim 2, we will examine whether the Hospital Readmissions Reduction Program (HRRP) - a federal policy that intended to improve HF care by financially penalizing hospitals with high 30-day readmission rates – has incentivized inappropriate post-discharge care strategies (i.e. avoiding indicated readmissions) that have been associated with increased mortality. Our preliminary data suggest that the rise in mortality is being driven by patients with HF who are not readmitted to the hospital, providing initial support for this hypothesis. In Aim 3, we will use semi-structured physician interviews to understand if their decision-making regarding the care of HF patients has changed since HRRP. In addition, we will interview patients with HF to explore their awareness and perception of this policy. These interviews will also be used to gather preliminary data on potential strategies to improve post-discharge HF care. The overarching goal of this proposal is to understand why short-term mortality among older adults with HF is rising in the United States, which may have significant clinical and policy implications. The first two aims of this analysis will inform whether more resources should be allocated to sites that care for clinically high-risk or socially disadvantaged populations and if current federal policies (HRRP) should be redesigned or eliminated. The third aim will lay the foundation for future research to develop and test novel strategies, based on physician and patient preferences, to improve post-discharge HF care. This research will be accomplished in the setting of a comprehensive career development program designed to provide Dr. Wadhera, an early career investigator and cardiologist, with the skills needed to become an independent investigator in cardiovascular medicine and health policy. His long-term career goal is to use large datasets at the population level, and qualitative methods at the individual level, to comprehensively evaluate the impact of health policies on cardiovascular care and outcomes. An outstanding mentoring team and advisory committee of established clinical investigators in the fields of cardiovascular medicine, outcomes research, health policy, and advanced biostatistical and qualitative methods will guide Dr. Wadhera in his transition to independence over the course of the award period. !

呢呢项目（摘要/摘要（美国老年人中心力衰竭（HF）的临床和财务燃烧很高，每年40万住院和300亿美元的支出。经过十年的短期改善现在有HF住院的老年人的期限死亡率，现在住院后30天内死亡率已在该人群的增加。但是，关于推动这一趋势的因素，知之甚少。研究建议使用行政和定性数据来评估患者，医院和政策水平因素这解释了死亡率上升。在AIM 1中，我们将使用Medicare数据来确定是否增加临床和/或社会在患有HF住院或担心医院护理质量的老年人中的风险，解释了最近的趋势死亡。在AIM 2中，我们将检查医院减少校园的减少计划（HRRP） - 联邦旨在通过以高30天再入院率对医院进行财务惩罚来改善HF护理的政策 - 激励了不适当的入境后护理策略（即避免了所指示的再入院）我们与死亡率增加有关。我们的初步数据表明，死亡率的增加正在驱动未入院的HF患者，为这一假设提供了最初的支持。目标 3，我们将使用半结构化的身体访谈来了解他们对护理的决策是否自HRRP以来，HF患者发生了变化。此外，我们将采访HF患者以探索他们的意识和对该政策的看法。这些访谈也将用于收集有关的初步数据改善病后HF护理的潜在策略。该提议的总体目标是了解为什么在美国，HF老年人的短期死亡率正在上升，这可能具有重要的临床和政策影响。该分析的前两个目标将告知是否应该更多资源分配给照顾临床上高风险或受到社会困扰的人群的网站，以及当前的联邦应重新设计或消除策略（HRRP）。第三个目标将为将来的研究奠定基础基于身体和患者的偏好制定和测试新型策略，以改善释放后HF 关心。这项研究将在综合职业发展计划的设置中完成旨在为早期职业调查员和心脏病专家Wadhera博士提供所需的技能成为心血管医学和卫生政策的独立研究者。他的长期职业目标是在人群层面使用大型数据集，以及在个人一级的定性方法，以全面评估健康政策对心血管护理和结果的影响。杰出在心血管领域的临床研究人员的指导团队和咨询委员会医学，结果研究，卫生政策以及高级生物统计学和定性方法将指导博士沃德拉（Wadhera）在整个奖项期间过渡到独立性。呢