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Heart Failure Readmissions in Older Adults: A Systems Perspective

老年人心力衰竭再入院：系统视角

基本信息

批准号：
8925630
负责人：
Leora Horwitz
金额：
$ 2.31万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-20 至 2014-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8925630
关键词：
Heart Failure Readmissions Older Adults

项目摘要

One quarter of older patients admitted for heart failure are readmitted within 30 days of discharge, resulting in increased morbidity for seniors and high healthcare costs. In an effort to reduce the readmission rate, a risk- standardized hospital readmission rate for heart failure is now publicly reported, and health reform proposals include penalties for hospitals with high readmission rates. Yet despite this intense public interest, the phenomenon of readmission is poorly understood, and risk-standardized readmission rates vary widely among hospitals. Since quality of hospital, transitional and post-discharge care plays an important role in readmission risk, we approach this problem from a systems perspective. My long-term goal is to develop a research career dedicated to improving healthcare systems at the local, regional and national level so that they maximize care quality, patient safety, coordination and communication for older patients. The goals of this proposal are to build my skillset in this area, acquire data for hypothesis testing and future interventions, and to expand my mentoring relationships to encompass geriatric and transitional care experts. The specific career development aims are: (1) to build a foundation of geriatric and aging-related knowledge; (2) to develop expertise in quality assessment in multiple domains using a variety of techniques; (3) to gain experience in the use and analysis of Medicare claims data, and in the integration and merging of a diverse group of large datasets; and (4) to develop advanced expertise in organizational behavior, human ergonomics, systems analysis and other techniques necessary for building safe and patient-centered healthcare systems. I will accomplish this through a combination of coursework, mentorship and research activities. The research goal of this proposal is to develop a better understanding of the modifiable healthcare delivery factors that have an impact on readmissions for geriatric patients. The specific research aims are: (1) to compare clinical, transitional, and post-discharge care for older patients with heart failure admitted to hospitals in the top, middle and bottom ten percent of readmission rates nationally; (2) to describe the etiology and preventability of readmissions in patients admitted to these hospitals; (3) to determine the proportion of variation in risk-standardized readmission rates for heart failure attributable to hospital referral region characteristics; and (4) to identify regional characteristics that are associated with readmission rates for older patients admitted with heart failure. My mentorship team includes experts in heart failure readmissions and quality measurement (H. Krumholz, E. Bradley), and an expert in multifactorial geriatric conditions (M. Tinetti). Relevance: Older patients have a disproportionately high risk of readmission after hospital discharge and are particularly vulnerable to inadequate healthcare systems. This study is intended to identify the areas in which clinicians, hospitals, and the healthcare environment have influence over readmission rates, in order to develop targeted, high-impact interventions to reduce morbidity in older patients after the hospital-to-home transition. NO CHANGE

四分之一因心力衰竭入院的老年患者在出院后30天内再次入院，导致

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Discontinuation of Antihyperglycemic Therapy After Acute Myocardial Infarction: Medical Necessity or Medical Error?

DOI：
10.1016/s1553-7250(12)38051-3
发表时间：
2012-09-01
期刊：
JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY
影响因子：
2.3
作者：
Lovig, Kay O.;Horwitz, Leora;Inzucchi, Silvio E.
通讯作者：
Inzucchi, Silvio E.

The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care.

患者交接：住院医师教育的综合课程蓝图，以提高护理的连续性。

DOI：
10.1097/acm.0b013e318248e766
发表时间：
2012
期刊：
Academic medicine : journal of the Association of American Medical Colleges
影响因子：
0
作者：
Wohlauer,MaxV;Arora,VineetM;Horwitz,LeoraI;Bass,EllenJ;Mahar,SeanE;Philibert,Ingrid;HandoffEducationandAssessmentforResidents(HEAR)ComputerSupportedCooperativeWorkgroup
通讯作者：
HandoffEducationandAssessmentforResidents(HEAR)ComputerSupportedCooperativeWorkgroup

Decade-long trends in mortality among patients with and without diabetes mellitus at a major academic medical center.

DOI：
10.1001/jamainternmed.2014.1803
发表时间：
2014-07
期刊：
JAMA INTERNAL MEDICINE
影响因子：
39
作者：
Butala, Neel M.;Johnson, Benjamin K.;Dziura, James D.;Reynolds, Jesse S.;Balcezak, Thomas J.;Inzucchi, Silvio E.;Horwitz, Leora I.
通讯作者：
Horwitz, Leora I.

An institution-wide handoff task force to standardise and improve physician handoffs.

DOI：
10.1136/bmjqs-2011-000658
发表时间：
2012-10
期刊：
BMJ quality & safety
影响因子：
5.4
作者：
Horwitz LI;Schuster KM;Thung SF;Hersh DC;Fisher RL;Shah N;Cushing W;Nunes J;Silverman DG;Jenq GY
通讯作者：
Jenq GY

Does Social Isolation Predict Hospitalization and Mortality Among HIV+ and Uninfected Older Veterans?