Unplanned Early Readmissions of Hospitalized Patients with Cirrhosis

项目总结 出院的肝硬变患者早期再住院率高， 这些重新入院对医疗保健系统来说是一个沉重的负担。减少重新入院是当务之急 对于医疗保健系统，但需要透彻地了解导致 重新入院。此外，许多再次入院的患者可能会从临终关怀转诊中受益， 在肝硬变患者中未得到充分利用，这也可能减少再次入院。这项建议 描述职业发展计划，使应聘者能够在以病人为本方面发展专业知识 通过获得卫生服务研究、实施科学、 姑息治疗和生物统计学。具体目标是：(1)确定疾病的发生率和预测因素 计划外30天再次住院的肝硬变患者；(2)确定与可预防相关的因素 非计划的30天再次住院；以及(3)制定标准，以确定哪些住院的肝硬变患者 适合临终关怀。为了实现这些目标，应聘者将(1)学习详细的多维 肝硬变住院患者的大样本前瞻性队列特征；(2)系统评估 重新接纳可预防；以及(3)利用修改后的德尔福共识程序召集专家小组，以 确定临终关怀资格的标准。 拟议的职业发展计划包括：由资深学生组成的多学科团队的密切指导 科学家；卫生服务研究、生物统计学、实施科学和 定性研究；通过实施拟议的研究计划进行体验式学习；以及高度 支持性的研究环境。导师团队，其中包括独立调查人员 在肝病(Chalasani)、卫生服务研究和临床转化研究方面的专业知识 实施科学(布斯塔尼)、姑息关怀和共识方法论(Sachs)以及观察性和 纵向数据分析和生物统计(GAO)，将指导候选人的研究和职业发展。 印第安纳大学的研究环境包括多学科合作组织，如 印第安纳州临床与转化科学研究所和卫生创新与健康中心 实施科学，这将有助于促进候选人的职业成长和职业发展。在… 该计划结束后，候选人将处于成为独立医生的有利地位- 从事肝硬变高质量健康服务研究的科学家。

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.