Unplanned Early Readmissions of Hospitalized Patients with Cirrhosis

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PROJECT SUMMARY Patients with liver cirrhosis who are discharged from the hospital have high rates of early hospital readmission, and these readmissions are a significant burden to the health care system. Reducing readmissions is a priority for the health care system, but requires a thorough understanding of modifiable risk factors leading to readmission. In addition, many patients who are readmitted to the hospital may benefit from hospice referral, which is underutilized in patients with cirrhosis, and which may also reduce readmissions. This proposal describes a career development plan that will enable the candidate to develop expertise in patient-oriented clinical research by acquiring the necessary skills in health services research, implementation science, palliative care, and biostatistics. The specific aims are to (1) determine the incidence and predictors of unplanned 30 day readmissions in patients with cirrhosis; (2) identify factors associated with preventable unplanned 30 day readmissions; and (3) develop criteria that identify hospitalized patients with cirrhosis who are suitable for hospice care. To achieve these aims, the candidate will (1) study detailed multidimensional characteristics of a large prospective cohort of hospitalized patients with cirrhosis; (2) systematically assess readmission preventability; and (3) convene an expert panel using the modified Delphi consensus process to identify criteria for hospice eligibility. The proposed career development plan integrates: close mentoring from a multidisciplinary team of senior scientists; advanced coursework in health services research, biostatistics, implementation science, and qualitative research; experiential learning through the conduct of the proposed research plan; and a highly supportive research environment. The mentorship team, which includes independent investigators with expertise in clinical and translational research in hepatology (Chalasani), health services research and implementation science (Boustani), palliative care and consensus methodology (Sachs), and observational and longitudinal data analysis and biostatistics (Gao), will guide the candidate's research and career development. The research environment at Indiana University includes multidisciplinary collaborative organizations such as the Indiana Clinical and Translational Sciences Institute and the Center for Health Innovation and Implementation Science, which will help foster the candidate's professional growth and career development. At the conclusion of this program, the candidate will be well positioned to become an independent physician- scientist conducting high quality health services research in cirrhosis.