An Innovative Model to Predict Readmissions in Adults with Cardiovascular Disease

描述(由申请者提供)：该项目启动了一个高度创新的跨学科研究计划，将促进我们对社会经济、心理社会、行为和临床因素如何预测成人心血管疾病(CVD)患者再次住院的理解。利用与联邦医疗保险索赔数据相关联的具有全国代表性的美国老年人两年一度的小组数据(1992-2010)，这项研究的具体目标有三个：首先，描述因三种主要心血管疾病之一[心力衰竭(HF)、缺血性心脏病(IHD)和中风]而住院的成年人的特征，并研究一系列基本上未经检验的患者特征与出院后未经调整的30天和180天全原因再次住院(或死亡)的关系。其次，开发一个稳健的风险模型来预测CVD患者的再入院情况，使用一系列多变量风险模型和绩效标准(校准和判别)来评估非临床和临床风险因素。第三，评估心血管疾病特定分类的模型(即心力衰竭、IHD和卒中)，以确定是否需要单独的模型来有效预测不良结果并对心血管患者的风险进行分层。性别、种族和地理差异将在心血管疾病模型(S)中进行测试，以评估其在不同领域潜在使用的灵活性和有效性 临床环境。这个应用程序的基础是我对社会和行为因素如何影响人类健康和老龄化的兴趣的延伸。然而，这项研究标志着与我以前的工作的转变，因为它需要在心血管疾病研究方面进行新的培训，并需要必要的指导，以将医疗保险索赔数据与社会调查数据相结合。在一个由导师(Eric Peterson博士和Lesley Curtis博士)和顾问(Gerardo Heiss博士、Kenneth Land博士和Redford Williams博士)组成的多学科互补团队的指导下，他们致力于我的发展和研究的成功，K01奖将为我提供保护时间，让我在心血管疾病研究中获得新的能力，并作为一名独立科学家发展。杜克大学提供了一个理想的环境，通过密集的指导、专业的课程作业、教学研讨会以及与多学科教师的协作互动，来实现我提出的研究和职业目标。作为我直接职业目标的一部分，我将利用该奖项加快我作为独立研究员的发展，并作为杜克大学的初级教员寻求R01资金。我的长期目标是开创心血管疾病跨学科研究的先河。了解成年心血管疾病患者不良后果的社会、心理和行为决定因素是2020年健康人和国家心肺血液研究所的主要目标。我相信，拟议的研究将提供必要的科学，以帮助确定高危患者，并将提供新的知识，以开发创新的工具，以减少人口中脆弱部分的过度疾病负担。

DESCRIPTION (provided by applicant): The proposed project initiates a program of highly innovative interdisciplinary research that will advance our understanding of how socioeconomic, psychosocial, behavioral, and clinical factors predict hospital readmissions in adults with cardiovascular disease (CVD). Using nationally representative biennial panel data of U.S. older adults (1992-2010) that are linked with Medicare claims data, the specific aims of this research are threefold: First, describe the characteristics of adults hospitalized for one of three major forms of CVD [heart failure (HF), ischemic heart disease (IHD), and stroke] and examine how an array of largely untested patient characteristics are associated with unadjusted 30-day and 180-day all-cause readmission (or death) after discharge. Second, develop a robust risk model to predict readmissions in CVD patients using a series of multivariate hazard models and performance criteria (calibration and discrimination) to assess the non-clinical and clinical risk factors. Third, evaluate models for specific classifications of CVD (i.e., HF, IHD, and stroke) to determine whether separate models are needed to effectively predict adverse outcomes and stratify risks among cardiovascular patients. Sex, race, and geographic differences will be tested in the CVD model(s) to assess its flexibility and effectiveness for potential use in diverse clinical settings. The foundation for this application is an extension of my interests in how socia and behavioral factors impact human health and aging. However, this research marks a shift from my previous work because it demands new training in the study of CVD and the guidance necessary to integrate Medicare claims data with social survey data. Under the direction of a multidisciplinary and complementary team of mentors (Drs. Eric Peterson and Lesley Curtis) and advisors (Drs. Gerardo Heiss, Kenneth Land, and Redford Williams) who are committed to my development and the success of my research, the K01 award will provide me protected time to acquire new competency in the study of cardiovascular disease and to develop as an independent scientist. Duke University provides an ideal environment to accomplish my proposed research and career goals through intensive mentorship, specialized coursework, didactic workshops, and collaborative interactions with multidisciplinary faculty. As part of my immediate career objectives, I will use the award to accelerate my development as an independent researcher and pursue R01 funding as a junior faculty member at Duke University. My long-term goal is to establish a career pioneering the interdisciplinary study of CVD. Understanding the social, psychosocial, and behavioral determinants of adverse outcomes in adults with CVD is a major goal of Healthy People 2020 and the National Heart, Lung, and Blood Institute. I am confident that the proposed research will provide the science necessary to help identify high-risk patients and will provide new knowledge to develop innovative tools to reduce the excess burden of disease in vulnerable segments of the population.