Effectiveness of Strategies to Improve Outcomes after Hospitalization for Acute Myocardial Infarction in Older Adults

改善老年人急性心肌梗死住院后预后的策略的有效性

基本信息

批准号：
10339915
负责人：
Sarwat I Chaudhry
金额：
$ 78.54万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10339915
关键词：
Accounting Acute myocardial infarction Address Affect Age Aging Ambulatory Care Biometry Cardiac Catheterization Procedures Cardiovascular system Caring Cognition Collaborations Cost Control Data Data Set Data Sources Diagnostic tests Discharge Plannings Disease Echocardiography Effectiveness Elderly Enrollment Epidemiology Evaluation Event Financial Hardship Gait speed Geriatric Assessment Health Status Health system Home Home Care Services Hospitalization Hospitals Incentives Inpatients Insurance Coverage Interview Measures Medical Records Medicare Modeling National Heart, Lung, and Blood Institute Outcome Outpatients Participant Patient Outcomes Assessments Patients Performance Physiological Prognosis Reporting Research Risk Services Severity of illness Social support Techniques Time Visit base care delivery cohort comorbidity depressive symptoms evidence based guidelines follow-up functional disability high risk hospital readmission improved improved outcome mortality mortality risk older patient payment primary outcome programs risk prediction risk prediction model

Accounting Acute myocardial infarction Address Affect Age Aging Ambulatory Care Biometry Cardiac Catheterization Procedures Cardiovascular system Caring Cognition Collaborations Cost Control Data Data Set Data Sources Diagnostic tests Discharge Plannings Disease Echocardiography Effectiveness Elderly Enrollment Epidemiology Evaluation Event Financial Hardship Gait speed Geriatric Assessment Health Status Health system Home Home Care Services Hospitalization Hospitals Incentives Inpatients Insurance Coverage Interview Measures Medical Records Medicare Modeling National Heart, Lung, and Blood Institute Outcome Outpatients Participant Patient Outcomes Assessments Patients Performance Physiological Prognosis Reporting Research Risk Services Severity of illness Social support Techniques Time Visit base care delivery cohort comorbidity depressive symptoms evidence based guidelines follow-up functional disability high risk hospital readmission improved improved outcome mortality mortality risk older patient payment primary outcome programs risk prediction risk prediction model

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项目摘要

Acute myocardial infarction (AMI) is consistently ranked as one of the top five most expensive conditions billed to Medicare and has been the target of several cost containment measures, including Medicare’s Hospital Readmissions Reduction Program. To improve outcomes after AMI hospitalizations, payers have implemented public reporting, financial penalties, and alternative payment models that incentivize the assumption of financial risk such as capitation. These measures have not been accompanied by evidence-based guidelines on how health systems can improve outcomes after hospitalization. An impediment to such guidance has been an incomplete understanding of patient-level factors that may influence the effectiveness of strategies to improve post-AMI hospitalization outcomes as applied in real-world settings. Notably, 30% of patients hospitalized for AMI are age ≥ 75. These patients have lower physiologic reserve and more functional impairments, including those in cognition and physical capabilities, than younger patients. In the SILVER-AMI study, we enrolled 3041 patients age ≥ 75 hospitalized for AMI at 94 hospitals. The primary objective was to evaluate the contribution of functional impairments and geriatric conditions to improving risk prediction for mortality within 6 months of hospital discharge. The premise of the SILVER-AMI study was that risk prediction at the time of discharge could identify high-risk patients who might benefit from more intensive post-hospital care. Findings from SILVER-AMI have demonstrated that functional impairments substantially improve risk prediction for important outcomes. We did not obtain Medicare data in this study so could not examine strategies being deployed in an effort to improve post-AMI outcomes. The overall objective of this proposal is to refine our understanding of the impacts of home health care (HHC) (Aim 1), early outpatient care (Aim 2), and Medicare Advantage (MA) (Aim 3) after AMI hospitalization by examining their effects in the context of functional impairments and illness severity. We will focus on outcomes of primary importance to older patients, including “home days” (days alive out of the hospital and other inpatient facilities) and health status, as well as disease-specific outcomes of relevance post-AMI. We will merge data from the SILVER-AMI study with Medicare data to achieve our aims. Combining these data sources will afford us the unique opportunity of accounting for an array of rigorously assessed covariates that are not generally available in studies using only administrative data and to identify patients who may benefit most from post-discharge services. In addition to accounting for a rich array of measured confounders, we will employ advanced statistical techniques to address bias from unmeasured confounding. We have assembled a team with a track record of collaboration and expertise in cardiovascular outcomes, home health care, outpatient care delivery, epidemiology, and biostatistics. This hypothesis-driven research will leverage the most comprehensive set of data on functional impairments and geriatric conditions collected during AMI hospitalization on a large, national cohort to inform strategies to improve outcomes of importance to older patients.

急性心肌梗塞（AMI）始终被评为最昂贵的五个最昂贵条件之一对Medicare，一直是Medicare医院在内的几项费用遏制措施的目标减少再入学计划。为了改善AMI住院后的结果，付款人已实施公开报告，经济罚款和替代付款模式，这些模式激励财务假设诸如大写之类的风险。这些措施尚未通过基于证据的指南积累卫生系统可以在住院后改善预后。对这种指导的障碍是对可能影响策略改善策略有效性的患者级因素的不完全理解现实环境中应用的AMI后住院结果。值得注意的是，有30％的患者住院 AMI年龄≥75岁。这些患者的生理储备较低和功能障碍，包括与年轻患者相比，认知和身体能力的人。在银色AMI研究中，我们注册了3041 ≥75岁的患者在94家医院住院。主要目的是评估功能障碍和老年状况，以在6个月内6个月内改善死亡率的风险预测医院出院。白银研究的前提是，出院时的风险预测可能确定可能受益于院后护理的高危患者。 Silver-Ami的发现已经证明，功能障碍大大改善了重要结果的风险预测。我们在这项研究中没有获得医疗保险数据，因此无法检查正在部署的策略以改进后的结果。该提案的总体目的是完善我们对家庭医疗保健（HHC）（AIM 1），早期门诊护理（AIM 2）和Medicare Advantage（MA）（AIM 3）AMI之后通过在功能障碍和疾病严重程度的背景下检查其影响来住院。我们将专注于对老年患者的主要重要性，包括“家庭日”（还活在医院之外以及其他住院设施）和健康状况，以及AMI后相关性的特定疾病结果。我们将将银色AMI研究中的数据与Medicare数据合并，以实现我们的目标。结合这些数据资料来源将为我们提供一系列严格评估的协变量的独特机会，这些机会通常在研究中仅使用行政数据并确定可能受益大多数的患者来自后收费服务。除了考虑丰富的测量混杂因素外，我们还将雇用先进的统计技术，以解决无法衡量的混杂因素的偏见。我们已经组建了一个团队心血管成果，家庭保健，门诊护理方面的协作和专业知识的记录分娩，流行病学和生物统计学。这项假设驱动的研究将利用最全面的关于在AMI住院期间收集的功能障碍和老年病情的数据集国家队列为提高对老年患者重要性的策略提供了信息。