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Functional, Cognitive, and Social Vulnerabilities and Hospital Readmission

功能、认知和社交脆弱性以及再入院

基本信息

批准号：
8707930
负责人：
Scott Ryan Greysen
金额：
$ 16.01万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8707930
关键词：
Acute Address Adult Affect Aging Area Attention Biometry California Caregivers Caring Cities Cognitive Data Data Analyses Data Collection Data Set Data Sources Diet Elderly Epidemiologic Studies Event Faculty Future Geriatrics Goals Health Health Care Reform Health Policy Healthcare Healthcare Systems Heart failure Hospitalists Hospitalization Hospitals Impaired cognition Influentials Inpatients Intervention Intervention Studies Interview K-Series Research Career Programs Lead Leadership Link Literature Measures Medicare Medicare claim Mentored Patient-Oriented Research Career Development Award Mentors Modeling Myocardial Infarction Outcome Outcomes Research Patient Discharge Patients Pharmaceutical Preparations Pneumonia Policies Policy Research Population Process Qualitative Methods Quality of Care Recovery Research Research Methodology Research Personnel Resources Retirement Risk Risk Assessment Risk Factors San Francisco Social Impacts Social support Subgroup Surveys Techniques Testing Time Universities base cohort cost data modeling design disability evidence base experience high risk hospital analysis hospital readmission implementation science improved multidisciplinary older patient patient oriented social social health determinants

项目摘要

DESCRIPTION (provided by applicant): This career development award will establish Dr. Ryan Greysen, a hospitalist at the University of California, San Francisco as a clinician-investigator focused on core geriatric vulnerabilities (functional, cognitive, and social) that impact hospital outcomes among older adults. This K23 award will provide Dr. Greysen the support needed to accomplish 4 goals: (1) to become an expert patient-oriented outcomes researcher in aging research; (2) to elucidate risk factors for readmission among vulnerable older adults and understand the mechanisms by which these factors directly impact patients/caregivers; (3) to develop expertise in mixed methods research through use of advanced quantitative and qualitative techniques (4) to develop leadership in health policy at the intersection of hospital medicine and geriatrics. To achieve these goals, Dr. Greysen has assembled an expert multidisciplinary team in geriatrics, quantitative and qualitative methods, and health policy research. His primary mentor, Dr. Kenneth Covinsky, has extensive experience in aging outcomes research and mentoring junior faculty to become independent investigators in aging research. His co-mentors are Dr. Andrew Auerbach, an expert in quantitative analysis of hospital quality of care and implementation science, and Dr. Daniel Dohan, a leading expert in qualitative analysis of social determinants of health and health policy. Dr. Greysen will also benefit from the expertise of two distinguished scientific advisors with expertise in advanced biostatistics and mixed methods research. Hospital readmission is a common, costly, and important event in the health trajectory of older adults. Dr. Greysen's research plan builds on his preliminary data to examine the impact of functional, cognitive, and social vulnerabilities on readmission for Medicare patients. He will study these effects by adding data about these vulnerabilities from the nationally-representative Health and Retirement Survey (HRS) to Medicare claims data and modeling the same analytical approach used by Medicare to penalize hospitals for higher than expected rates of 30-day readmission (Aim1a-c). To maximize the immediate policy impact of this research, Dr. Greysen will also conduct a subgroup analysis of patients admitted with heart failure, heart attack, or pneumonia to mirror the initial implementation of this controversial Medicare policy in 2012 (Aim 1d). Dr. Greysen will also conduct in-depth qualitative data collection and analysis with hospitalized older adults with functional, cognitive, and social vulnerabilities recently discharged from two hospitals (one large public and one large academic hospital) in one city (Aim 2). This aim will explore mechanisms by which vulnerability directly impacts efforts of older adults and caregivers to recuperate from hospitalization and enable future interventions targeting these patients. This research plan leverages existing UCSF and NIA resources of Dr. Covinsky's geriatric outcomes research group and the HRS-Medicare dataset. Finally, this research will form the basis for an R01 application to study interventions to improve outcomes of transition care for hospitalized older adults.

描述（由申请人提供）：该职业发展奖将确定加州大学旧金山分校的住院医师 Ryan Greysen 博士为临床医生研究员，专注于影响老年人医院治疗结果的核心老年脆弱性（功能、认知和社交）。该 K23 奖项将为 Greysen 博士提供实现 4 个目标所需的支持：(1) 成为衰老研究领域以患者为导向的结果专家研究员； (2) 阐明弱势老年人再入院的风险因素，并了解这些因素直接影响患者/护理人员的机制； (3) 通过使用先进的定量和定性技术来发展混合方法研究的专业知识 (4) 在医院医学和老年病学的交叉领域发展卫生政策的领导力。为了实现这些目标，格雷森博士组建了一个老年病学、定量和定性方法以及卫生政策研究领域的多学科专家团队。他的主要导师肯尼思·科文斯基博士在老龄化结果研究和指导初级教师成为老龄化研究的独立调查员方面拥有丰富的经验。他的共同导师是安德鲁·奥尔巴赫博士（医院护理质量和实施科学定量分析专家）和丹尼尔·多汉博士（健康问题社会决定因素定性分析和卫生政策领先专家）。格雷森博士还将受益于两位杰出科学顾问的专业知识，他们在先进生物统计学和混合方法研究方面拥有专业知识。再入院是老年人健康轨迹中常见、昂贵且重要的事件。格雷森博士的研究计划以他的初步数据为基础，研究功能、认知和社会脆弱性对医疗保险患者重新入院的影响。他将通过将全国代表性健康和退休调查 (HRS) 中有关这些漏洞的数据添加到 Medicare 索赔数据中来研究这些影响，并对 Medicare 使用的相同分析方法进行建模，以惩罚高于预期 30 天再入院率的医院 (Aim1a-c)。为了最大限度地发挥这项研究的直接政策影响，Greysen 博士还将对因心力衰竭、心脏病发作或肺炎入院的患者进行亚组分析，以反映 2012 年这项有争议的医疗保险政策的初步实施（目标 1d）。格雷森博士将还对最近从两家医院（一家大型医院）出院的具有功能、认知和社会脆弱性的住院老年人进行深入的定性数据收集和分析公立医院和一所大型学术医院）在一个城市（目标 2）。这一目标将探索脆弱性直接影响老年人和护理人员从住院中恢复的努力的机制，并使得未来能够针对这些患者采取干预措施。该研究计划利用了 Covinsky 博士老年结果研究小组的现有 UCSF 和 NIA 资源以及 HRS-Medicare 数据集。最后，这项研究将为 R01 应用奠定基础，以研究改善住院老年人过渡护理结果的干预措施。