Determinants, Outcomes, and Financial Incentives Associated with Cardiac Rehabilitation Enrollment After Cardiac Surgery

项目摘要/摘要 候选人：迈克尔·P·汤普森博士，流行病学家、卫生服务研究员和教职员工 密歇根大学心脏外科教授。他的长期职业目标是 进行有影响力的、有意义的和创新的研究，以提高心脏手术的价值。这个 拟议的K01奖项申请包括所需的职业发展和研究活动的5年计划 实现这一职业目标，成为一名成功的独立调查员。 背景：心脏康复(CR)是一项多学科、循证的干预措施，可以改善 结果，但尚未被广泛采用。在心脏手术患者中，临床试验表明 CR延长生命，改善心血管功能和生活质量，并防止下游医疗保健 利用率。尽管有这些证据，一半的心脏手术患者从未参加过一次CR会议，而且只有 三分之一的CR参与者完成了全部36个推荐课程。不同地区的CR注册人数存在差异 还在患者、提供者和地理区域之间进行了演示。提高CR注册人数是 对于确保心脏手术患者充分发挥其潜力至关重要。 研究目的：我的长期目标是提高心脏外科护理的价值。这项研究的目的 (1)确定心脏手术后CR登记的决定因素，(2)衡量CR的效果 心脏手术后的登记对临床和经济结果的影响，以及(3)估计财务的影响 心脏手术后CR登记的激励措施。为了实现这些目标，我们提出了一系列 对来自改进网络的索赔数据和临床数据的独特组合进行量化分析， 共享五个多中心心血管质量协作项目的数据和最佳实践 9个州的90多家医院(约占美国心脏外科项目的10%)。 培训目标：提出了三个培训目标，以促进这项提议。(一)深入了解 对心脏外科护理服务的理解。(2)通过深入比较，获得因果推理技能 有效性和政策评估部分。(3)培养实施技能和经验 科学的方法。 影响：本提案的调查结果将提供必要的证据，以开发必要的证据 适当扩大和激励心脏手术后的CR登记，这将增加 心脏外科护理。该建议直接回应了AHRQ对(I)生成证据的兴趣，该证据将 提高医疗负担能力、效率和质量，以及(Ii)医疗服务研究，以实现更高的 重视医疗保健系统。最重要的是，拟议的研究战略、职业发展计划、指导、 制度环境将把我培养成一名独立的卫生服务研究员。

PROJECT SUMMARY/ABSTRACT CANDIDATE: Michael P. Thompson, PhD, is an epidemiologist, health services researcher, and faculty member in the Department of Cardiac Surgery at the University of Michigan. His long-term career goal is to conduct impactful, significant, and innovative research that improves the value of cardiac surgery. The proposed K01 award application includes a 5-year plan for career development and research activities needed to achieve this career goal and become a successful independent investigator. BACKGROUND: Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention that improves outcomes, but has not been widely adopted. Among cardiac surgical patients, clinical trials have demonstrated that CR extends life, improves cardiovascular function and quality of life, and prevents downstream health care utilization. Despite this evidence, half of cardiac surgical patients never attend a single session of CR, and only one-third of CR enrollees finish the entire 36 recommended sessions. Disparities in CR enrollment across have also been demonstrated across patients, providers, and geographic regions. Improving CR enrollment is critical to ensuring its full potential for cardiac surgical patients. RESEARCH AIMS: My long-term goal is to improve the value of cardiac surgical care. The aims of this study are: (1) to identify determinants of CR enrollment after cardiac surgery, (2) to measure the effect of CR enrollment after cardiac surgery on clinical and economic outcomes, and (3) to estimate the impact of financial incentives on CR enrollment after cardiac surgery. In order to achieve these objectives, we propose a series of quantitative analyses on a unique combination of claims data and clinical data from the IMPROVE Network, which shares data and best practices across five multicenter cardiovascular quality collaboratives covering over 90 hospitals in 9 states (~10% of all US cardiac surgical programs). TRAINING AIMS: Three training aims have been proposed to facilitate the proposal. (1) To gain a deeper understanding of cardiac surgical care delivery. (2) To gain causal inference skills with in-depth comparative effectiveness and policy evaluation components. (3) To develop skills and experience in implementation science methods. IMPACT: Findings from this proposal will provide evidence needed to develop the necessary evidence to appropriately expand and incentivize CR enrollment after cardiac surgery, which will increase the value of cardiac surgical care. The proposal is directly responsive to AHRQ’s interest in (i) generating evidence that will increase the affordability, efficiency, and quality of health and (ii) health services research to achieve a high- value healthcare system. Above all, the proposed research strategy, career development plan, mentorship, and institutional environment will cultivate my growth into an independent health services researcher.