Improvement in Patients' Cognition and Relationship with SNF Quality Measures

项目总结/摘要 我是德克萨斯大学医学分支康复科学系的助理教授 在德克萨斯州的加尔维斯顿。这个K 01提案的目的是为我提供知识，分析技能， 成为一名成功的调查员所需的经验。对我来说，这意味着我将建立一个有资金的 一项研究计划，旨在提高老年人急性期后护理的质量，特别是那些 认知障碍、阿尔茨海默病和相关痴呆症。我的K 01申请专注于熟练的 护理设施（SNF），因为它们是老年人最常见的急性后护理场所。我的训练 老年学专注于分析认知数据，并使用大型数据集来识别潜在的可修改的 认知障碍和痴呆的危险因素。在K 01期间，我将接受四个方面的培训 这些知识建立在我之前接受的老年学培训和痴呆症流行病学专业知识的基础上：（1）健康 与老年人相关的特征、评估过程、质量结果和随访需求 （2）SNF的运营标准和监管（决策）政策;（3）统计 使用索赔数据研究急性期后护理结果的技能;（4）职业发展和领导能力 发展这些领域的培训将包括课程作业，在临床实践中跟踪跨学科团队， 设置，以及访问、管理和分析Medicare文件的体验。这次训练会让我成为 研究人员与医疗保健政策和临床背景的高度知情的看法。我的训练活动 我将与一个研究项目相结合，在该项目中，我将使用国家医疗保险数据文件（2012-2014）来完成 以下具体目标：（A）评估老年人在SNF停留期间认知状态的变化， 入院时认知受损;（B）检查SNF之间的变化， 入院时认知受损，其认知状态在SNF停留期间改善;以及（C）评估 入院时认知状态、SNF住院期间认知状态改善之间的关系，以及 SNF质量指标。这项研究的预期结果可以为临床干预提供信息 针对与改善认知状态相关的患者和机构水平特征。这些发现可以 还为旨在激励疗养院提供高质量急性期后护理的医疗保健政策提供信息。 完成K 01指导培训和研究计划将为我提供知识和技能 有必要制定一项研究计划，以提高老年人急性期后护理的质量， 特别是对于患有认知障碍、阿尔茨海默病和相关痴呆症的老年人。

PROJECT SUMMARY/ABSTRACT I am an assistant professor in the Division of Rehabilitation Sciences at the University of Texas Medical Branch in Galveston, Texas. The purpose of this K01 proposal is to provide me with the knowledge, analytical skill, and experience necessary to become a successful investigator. To me, this means I will develop a funded research program that advances the quality of post-acute care for older adults, in particular for those with cognitive impairment, Alzheimer's disease and related dementias. My K01 application is focused on skilled nursing facilities (SNFs) because they are the most frequent post-acute care site for older adults. My training in gerontology has focused on analyzing cognitive data and using large data sets to identify potentially modifiable risk factors for cognitive impairment and dementia. During the K01 period, I will receive training in four areas that build upon my prior training in gerontology and expertise on the epidemiology of dementia: (1) Health characteristics, assessment process, quality outcomes and follow-up needs associated with older adults receiving SNF care; (2) Operational standards and regulatory (decision making) policies of SNFs; (3) Statistical skills for studying post-acute care outcomes using claims data; and (4) Career advancement and leadership development. Training in these areas will include coursework, shadowing interdisciplinary teams in clinical settings, and experiences accessing, managing, and analyzing Medicare files. This training will make me a researcher with a highly-informed view of healthcare policy and clinical context. My training activities have been integrated with a research project in which I will use national Medicare data files (2012-2014) to complete the following specific aims: (A) Evaluate the change in cognitive status during a SNF stay for older adults with impaired cognition on admission; (B) Examine the variation across SNFs in the percentage of patients with impaired cognition on admission whose cognitive status improves during a SNF stay; and (C) Assess the relationship between cognitive status on admission, improvement in cognitive status during a SNF stay, and performance on SNF quality measures. The expected findings of this research can inform clinical interventions that target patient- and facility-level characteristics associated with improved cognitive status. The findings can also inform healthcare policies meant to incentivize nursing homes to provide high-quality post-acute care. Completion of the K01 mentored training and research plans will provide me with the knowledge and skills necessary to develop a program of research that will advance the quality of post-acute care for older adults, in particular for older adults with cognitive impairment, Alzheimer's disease and related dementias.