Explaining Rising Heart Failure Mortality in Medicare

好了！ 好了！ 项目(摘要/摘要( 美国老年人心力衰竭(HF)的临床和经济负担很高，超过 每年住院400,000人次，支出300亿美元。在经历了十年的稳步改善之后- 因心力衰竭住院的老年人的长期死亡率，出院后30天内的死亡率现在是 在这个人口中不断增加。然而，人们对推动这一令人担忧的趋势的因素知之甚少。这 研究建议使用管理和定性数据来评估患者、医院和政策层面的因素 这就解释了死亡率上升的原因。在目标1中，我们将使用医疗保险数据来确定是否增加临床和/或社会 老年人患心力衰竭住院的风险，或医院护理质量恶化，解释了最近的趋势 死亡率。在目标2中，我们将审查医院再入院减少计划(HRRP)--一项联邦 旨在通过对30天再住院率较高的医院进行经济处罚来改善心力衰竭护理的政策- 鼓励不适当的出院后护理策略(即避免指定的重新入院) 与死亡率的增加有关。我们的初步数据表明，死亡率的上升是 未再次入院的心衰患者，初步支持这一假说。在AIM 3，我们将使用半结构化的医生访谈来了解他们关于护理的决策 HRRP治疗后，心衰患者发生了变化。此外，我们还将采访心力衰竭患者，以探索他们的 对这一政策的认识和认知。这些访谈还将被用来收集关于 改善出院后心衰护理的潜在策略。这项建议的首要目标是理解 为什么美国老年心力衰竭患者的短期死亡率在上升，这可能对 临床和政策方面的影响。这项分析的前两个目标将告知是否应该增加资源 分配到照顾临床高危或社会弱势人群的地点，如果当前联邦政府 政策(HRRP)应重新设计或取消。第三个目标将为今后的研究奠定基础 根据医生和患者的喜好，开发和测试新的策略，以改善出院后心衰 关心。这项研究将在一个全面的职业发展计划的背景下完成 旨在为职业生涯早期的调查员和心脏病专家瓦列卡博士提供所需的技能 成为心血管医学和卫生政策的独立调查者。他的长期职业目标是 在人口层面使用大型数据集，在个人层面使用定性方法，以 全面评估卫生政策对心血管护理和预后的影响。一位杰出的 心血管领域资深临床研究人员的指导团队和咨询委员会 医学、结果研究、卫生政策以及先进的生物统计学和定性方法将指导Dr。 在颁奖期间，瓦维拉在他向独立的过渡中。 好了！

! ! 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. !