Unplanned Early Readmissions of Hospitalized Patients with Cirrhosis

项目摘要 肝硬化患者出院后早期再入院率高， 并且这些再入院对卫生保健系统来说是一个重大负担。减少再入院是当务之急 但需要彻底了解可改变的风险因素， 再入院此外，许多再次入院的患者可能会从临终关怀转诊中受益， 其在肝硬化患者中未被充分利用，并且其也可以减少再入院。这项建议 描述了职业发展计划，该计划将使候选人能够发展以患者为导向的专业知识 临床研究，通过获得必要的技能，在卫生服务研究，实施科学， 姑息治疗和生物统计学具体目标是（1）确定以下疾病的发生率和预测因素： 肝硬化患者计划外30天再入院;（2）确定与可预防的 计划外30天再入院;（3）制定标准，确定肝硬化住院患者， 适合临终关怀。为了实现这些目标，候选人将（1）研究详细的多维 肝硬化住院患者大型前瞻性队列的特征;（2）系统评估 再入院可预防性;（3）使用修改后的德尔菲共识流程召集专家小组， 确定临终关怀资格标准。 拟议的职业发展计划包括： 科学家;在卫生服务研究，生物统计学，实施科学，和 质的研究;通过拟议的研究计划进行体验式学习;以及高度 支持性研究环境。指导小组，其中包括独立调查员， 肝病学（Chalasani）临床和转化研究的专业知识，卫生服务研究和 实施科学（Boustani）、姑息治疗和共识方法（Sachs）以及观察和 纵向数据分析和生物统计学（高），将指导候选人的研究和职业发展。 印第安纳州大学的研究环境包括多学科协作组织，如 印第安纳州临床和转化科学研究所和健康创新中心， 实施科学，这将有助于促进候选人的专业成长和职业发展。在 该计划的结论，候选人将很好地定位成为一个独立的医生- 科学家在肝硬化中进行高质量的卫生服务研究。

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.