An Innovative Model to Predict Readmissions in Adults with Cardiovascular Disease

该项目启动了一项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心血管疾病（CVD）成人再入院的理解。使用美国老年人两年一次的全国代表性面板数据（1992-2010）与医疗保险索赔数据相关联，本研究的具体目标有三个方面：首先，描述因三种主要形式的CVD之一[心力衰竭（HF），缺血性心脏病（IHD），和中风]，并检查一系列基本上未经测试的患者特征如何与出院后未调整的30天和180天全因再入院（或死亡）相关。其次，开发一个强大的风险模型，预测再入院的心血管疾病患者使用一系列的多变量风险模型和性能标准（校准和歧视），以评估非临床和临床风险因素。第三，评估CVD特定分类的模型（即，HF、IHD和卒中），以确定是否需要单独的模型来有效预测心血管患者的不良结局和分层风险。将在CVD模型中测试性别、种族和地理差异，以评估其在多种疾病中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衰老的兴趣的延伸。然而，这项研究标志着我以前工作的转变，因为它需要在CVD研究中进行新的培训，并需要将医疗保险索赔数据与社会调查数据相结合的指导。在一个多学科和互补的导师团队（Drs. Eric Peterson和Lesley Curtis）和顾问（Drs. Gerardo Heiss，Kenneth Land和Redford威廉姆斯）的指导下，他们致力于我的发展和我的研究的成功，K 01奖将为我提供受保护的时间，以获得心血管疾病研究的新能力，并发展为独立的科学家。杜克大学提供了一个理想的环境，通过密集的指导，专业课程，教学研讨会，并与多学科教师的协作互动，实现我提出的研究和职业目标。作为我近期职业目标的一部分，我将利用该奖项来加速我作为一名独立研究人员的发展，并作为杜克大学的一名初级教员寻求R 01资金。我的长期目标是建立一个开拓CVD跨学科研究的职业生涯。了解CVD成人不良结局的社会，心理和行为决定因素是2020年健康人群和国家心脏，肺和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，以帮助确定高风险患者，并将提供新的知识，以开发创新工具，减少人口中脆弱群体的过度疾病负担。

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.