Addressing social vulnerabilities to prevent hospital readmissions in adults with cardiovascular disease

解决社会脆弱性，防止患有心血管疾病的成人再次入院

• 批准号: 10221766
• 负责人: Oanh Kieu Nguyen
• 金额: $ 17.97万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-18 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10221766
• 关键词: Acute myocardial infarction; Address; Adult; Affect; Area; Attention; Award; Biometry; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical; Communities; Complication; Congestive Heart Failure; County; Data; Development; Doctor of Philosophy; Economics; Education; Electronic Health Record; Emergency Situation; Evaluation; Food; Funding; Goals; Health; Health Policy; Health Services Research; Health system; Heart; Home; Hospitalization; Hospitals; Housing; Income; Individual; Influentials; Information Technology; Inpatients; Intervention; Interview; K-Series Research Career Programs; Medical; Mentors; Mentorship; Methods; Modeling; Myocardial Ischemia; Outcome; Outcomes Research; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Policies; Prevention strategy; Process; Qualitative Methods; Randomized Controlled Trials; Recovery; Research; Research Personnel; Resources; Series; Severities; Social Work; Social isolation; Social support; System; Techniques; Training; Transportation; United States Agency for Healthcare Research and Quality; Visit; World Health; base; behavioral health; care coordination; care delivery; career development; community intervention; community organizations; computerized; design; evidence base; experience; faculty mentor; food insecurity; good diet; high risk; hospital readmission; implementation science; improved; innovation; novel; patient oriented; predictive modeling; prevent; readmission risk; research and development; risk prediction model; risk stratification; safety net; service organization; social; social health determinants; social interventions; social vulnerability; success; therapy development

PROJECT SUMMARY/ABSTRACT This career development award will establish Dr. Oanh Nguyen as a clinician-investigator focused on designing, implementing, and evaluating transitional care interventions to improve health outcomes for vulnerable patients with cardiovascular illness. This award will provide support needed to develop her expertise in: 1) advanced methods in patient-centered outcomes research (PCOR); 2) social determinants of health; and 3) intervention development, implementation, and evaluation in real-world health settings. To achieve these goals, Dr. Nguyen has assembled an expert mentorship team. Her primary mentor, Ethan Halm, MD, MPH, has extensive experience in health services research, PCOR, predictive modeling, intervention development, and training and mentoring faculty. Her co-mentor, Simon Lee, PhD is a medical anthropologist with expertise in qualitative methods, PCOR, and implementation science. Additional scientific advisors include Song Zhang, PhD, an expert in advanced biostatistics and predictive modeling techniques; and Sandeep Das, MD, an expert in implementation and evaluation of evidence-based cardiovascular care delivery interventions. Readmission within 30 days of hospitalization occurs in up to 1 in 5 adults, and patients with congestive heart failure (CHF) and ischemic heart disease (IHD) are among those at highest risk. Despite federal financial `readmissions penalties' for cardiovascular and other conditions, the most effective strategy to prevent readmissions remains unknown. Current interventions focus on improving medical care processes, but do not address deeper social vulnerabilities such as food and housing insecurity or behavioral health needs associated with higher readmission risk. Informed by her clinical experience and preliminary studies, Dr. Nguyen will conduct a series of studies to: 1) develop predictive models to identify hospitalized patients with CHF and IHD at high risk for readmission, and to stratify individuals by medical severity and social vulnerabilities (Aim 1); 2) conduct qualitative interviews of high-risk patients to understand patient perspectives on how social vulnerabilities affect medical recovery from CHF and IHD, and on the acceptability of community- based interventions to address these vulnerabilities (Aim 2); and 3) develop, pilot, and assess the feasibility of a transitional care intervention enhanced to address social vulnerabilities in addition to traditional medical needs (Aim 3), incorporating an innovative social-health information exchange (Dallas Information Exchange Portal). This research plan leverages existing institutional resources, including Dr. Halm's AHRQ-funded UT Southwestern (UTSW) Center for PCOR; the UTSW CTSA; and novel information technology. This training and research will form the basis for an R01 application for a fully powered randomized controlled trial to assess the impact of a risk-stratified readmission prevention strategy that addresses both social and medical vulnerabilities to prevent readmissions and improve health outcomes in CHF and IHD.

项目总结/摘要 这个职业发展奖将确立Oanh Nguyen博士作为临床研究者的地位， 设计、实施和评估过渡性护理干预措施，以改善以下人群的健康状况： 易受伤害的心血管疾病患者该奖项将提供所需的支持，以发展她的专业知识 在：1）以患者为中心的结果研究（PCOR）的先进方法; 2）健康的社会决定因素;以及 3)在现实世界的健康环境中制定、实施和评估干预措施。实现这些 为了实现这些目标，阮博士组建了一个专家指导团队。她的主要导师伊桑·哈尔姆医学博士公共卫生硕士 在卫生服务研究、PCOR、预测建模、干预开发方面拥有丰富的经验， 培训和指导教师。她的共同导师西蒙·李博士是一位医学人类学家， 在定性方法、变革和组织振兴方案和实施科学方面。其他科学顾问包括张松， 高级生物统计学和预测建模技术专家Sandeep Das，医学博士， 在实施和评估循证心血管护理提供干预措施。 高达五分之一的成人在住院后30天内再次入院，充血性心力衰竭患者 心力衰竭（CHF）和缺血性心脏病（IHD）是最高风险的。尽管联邦财政 对心血管疾病和其他疾病的“重新入院处罚”，是预防和治疗这些疾病的最有效战略。 再入院情况仍然未知。目前的干预措施侧重于改善医疗保健过程，但没有 解决更深层次的社会脆弱性，如粮食和住房不安全或行为健康需求 与较高的再入院风险相关。根据她的临床经验和初步研究，博士。 Nguyen将进行一系列研究，以：1）开发预测模型，以识别患有 CHF和IHD具有再次入院的高风险，并根据医学严重程度和社会因素对个体进行分层。 脆弱性（目标1）; 2）对高风险患者进行定性访谈，以了解患者的观点 社会脆弱性如何影响CHF和IHD的医疗恢复，以及社区的可接受性- 基于干预措施，以解决这些脆弱性（目标2）;和3）开发，试点，并评估的可行性， 加强过渡性护理干预措施，以解决除传统医疗外的社会脆弱性 需要（目标3），纳入创新的社会卫生信息交换（达拉斯信息交换 Portal）。这项研究计划利用现有的机构资源，包括博士。 西南（UTSW）PCOR中心; UTSW CTSA;和新的信息技术。本培训和 研究将构成R 01申请的基础，用于一项完全有效的随机对照试验，以评估 针对社会和医疗问题的风险分层再入院预防策略的影响 预防CHF和IHD患者再入院和改善健康结局的脆弱性。

项目成果

National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014-2018.

急诊就诊和住院期间酒精和其他物质使用障碍的全国患病率：NHAMCS 2014-2018。

• DOI: 10.1007/s11606-021-07069-w
• 发表时间: 2022-08
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Suen LW;Makam AN;Snyder HR;Repplinger D;Kushel MB;Martin M;Nguyen OK
• 通讯作者: Nguyen OK