Predicting Pediatric Readmission: Development of a Validated Risk Prediction Tool

项目总结 奥格医生是一名儿科住院医生，他的首要职业目标是防止不必要的住院治疗。 项目概述：儿科再入院很常见，但临床医生目前还没有系统的方法 以预测哪些患者出院后将再次计划外住院。这项提议的目的是 1)确定出院医疗复杂性的标志，并检查它们与再入院的关系；2) 为单一儿童医院的计划外再入院开发再入院风险预测工具；3)验证 第二家儿童医院的再入院风险预测工具。 候选人：奥格尔医生是辛辛那提医院医学部儿科助理教授 儿童医院医学中心。她已经完成了两项奖学金：临床奖学金 医院医学和罗伯特·伍德·约翰逊基金会临床学者计划奖学金 健康服务研究。作为RWJF奖学金的一部分，她还完成了健康和 医疗保健研究。拟议的K08职业发展计划建立在她的团契培训和 早期职业发展，解决四个需要额外培训的领域，以增强她的职业发展轨迹 成为一名独立的调查员：培训目标1.增加先进统计原理方面的专门知识。 风险预测方面的专业知识将是预测儿童再入院风险的基本技能。此外, 理解分层建模对于未来关注医院结果的研究将是至关重要的。 培训目标2.获得关于健康的社会决定因素的额外培训。社会风险已经被证明是 影响出院后风险。奥格尔博士需要在衡量社会决定因素方面进行额外的培训 确保在风险预测工具中使用最好的方法来考虑此类风险因素。培训目标3。 掌握制定和实施干预措施的技能。到目前为止，奥格尔博士的培训还没有包括 实施科学或干预试验。她将需要这两项技能来促进进一步的发展 以及在随后的R奖期间对旨在防止再次入院的干预措施进行测试。培训 目标4.加强学术和职业发展技能。奥格尔博士将继续发展技能 需要通过领导力和写作、审查等课程成为一名成功的独立调查员 手稿，参加“K俱乐部”，并在全国会议上发表。 指导关系：Samir S.Shah博士和Robert S.Kahn博士，并担任Auger博士的联合 主要导师。沙阿医生是儿科住院治疗方面的专家。他目前是PCORI资助的私家侦探 医院到家庭的过渡补助。卡恩博士是健康的社会决定因素方面的专家，此前 获得了R01水平的资金，用于研究儿童哮喘再入院的差异。另外两位共同导师 完成了奥格博士的导师团队：玛丽亚·T·布里托博士和马修·M·戴维斯博士。布里托博士是一位 具有实施科学方法论专业知识的慢性病管理。戴维斯医生是一名儿科医生 西北大学卫生政策专家，前州首席医疗执行官 密歇根州。在奥格尔博士担任RWJF研究员期间，他是她的研究员导师，并监督了许多 这项提案的基础工作包括为AIMS 1和2获取数据。 在过去的一年里，戴维斯作为导师团队每季度与奥格博士会面，并将继续这样做 在整个获奖期内，作为职业发展咨询委员会。 环境：预防重新入院是该机构的高度优先事项。拟议的职业发展 PLAN利用辛辛那提大学和CCHMC提供的智力资源，以及 国家认可的研讨会和课程，以补充当地培训。作为一个机构，CCHMC是 致力于通过内部拨款、行政支持和结构化支持来支持初级教职员工 教职员工网络和教育的机会。奥格尔博士是医院医学部的成员 在CCHMC。该科是世界上最注重研究的儿科医院医学部之一。 国家。奥格尔博士得到了广泛的支持，包括杰出的导师(上图)、计算机和软件， 生物统计顾问、数据管理支持、临床研究协调员、赠款管理支持、 其他初级教员研究人员的干部，以及可自由支配的资金。奥格尔博士也是CCHMC的成员 詹姆斯·M·安德森健康系统卓越中心，一个全国知名的研究部门， 重点评估和改善儿科保健服务的提供情况。 摘要：这项创新的研究提案将产生首个经过验证的儿科风险预测工具 计划外的重新入院。该建议与AHRQ的安全和质量优先领域非常一致。它的重点是 AHRQ优先群体，包括儿童和残疾儿童。奥格尔博士的研究和临床 培训、以前的研究经验和出色的指导团队使她非常适合从事这项工作 研究领域。这一奖项将为她提供未来成功所需的研究培训 制定干预措施以防止再次入院。此外，这一职业发展奖将促进 奥格尔医生发展成为全国公认的儿科医院医学独立研究员。

PROJECT SUMMARY Dr. Auger is a pediatric hospitalist whose overarching career goal is to prevent unnecessary hospitalization. Overview of Project: Pediatric readmission is common; yet, clinicians currently do not have a systematic way to predict which patients will return for an unplanned readmission after discharge. The aims of this proposal are to 1) identify markers of discharge medical complexity and examine their association with readmission; 2) develop a readmission risk prediction tool for unplanned readmission at a single children's hospital; 3) validate the readmission risk prediction tool at a second children's hospital. Candidate: Dr. Auger is an Assistant Professor of Pediatrics in the Division of Hospital Medicine at Cincinnati Children's Hospital Medical Center (CCHMC). She has completed two fellowships: a clinical fellowship in hospital medicine and a Robert Wood Johnson Foundation (RWJF) Clinical Scholars program fellowship in health services research. As part of her RWJF fellowship, she also completed a Masters of Health and Healthcare Research. The proposed K08 career development plan builds upon her fellowship training and early career development to address four areas that require additional training to enhance her trajectory toward becoming an independent investigator: Training Goal 1. Increase expertise on advanced statistical principles. Expertise in risk prediction will be an essential skill for predicting readmission risk for children. In addition, understanding hierarchical modeling will be essential for future research that focuses on hospital outcomes. Training Goal 2. Acquire additional training in social determinants of health. Social risks have been shown to influence post-discharge risk. Dr. Auger requires additional training in the measurement of social determinants to ensure use of the best methods to account for such risk factors in risk prediction tools. Training Goal 3. Acquire skills for developing and implementing interventions. Dr. Auger's training to date has not included implementation science or intervention trials. She will need both of these skills to facilitate further development and testing of interventions targeted to the prevention of readmission during a subsequent R award. Training Goal 4. Strengthen academic and professional development skills. Dr. Auger will continue to develop skills needed to be a successful independent investigator through courses on leadership and writing, reviewing manuscripts, participating in “K club”, and presenting at national conferences. Mentoring Relationships: Dr. Samir S. Shah and Dr. Robert S. Kahn and are serving as Dr. Auger's co- primary mentors. Dr. Shah is an expert in pediatric hospitalizations. He currently is the PI on a PCORI-funded hospital to home transitions grant. Dr. Kahn is an expert in the social determinants of health, having previously received R01 level funding for studying disparities in pediatric asthma readmission. Two other co-mentors complete Dr. Auger's mentorship team: Dr. Maria T. Britto and Dr. Matthew M. Davis. Dr. Britto is an expert in chronic disease management with expertise in implementation science methodology. Dr. Davis is a pediatric health policy expert at Northwestern University and is the former Chief Medical Executive for the state of Michigan. He was Dr. Auger's fellowship mentor during her RWJF fellowship and supervised much of the foundational work for this proposal including the acquisition of data for Aims 1 and 2. Drs. Kahn, Shah, Britto, and Davis have met as a mentorship team quarterly for the past year with Dr. Auger and will continue to do so throughout the award period as a career development advisory committee. Environment: Readmission prevention is a high priority for the institution. The proposed career development plan utilizes the intellectual resources available through the University of Cincinnati and CCHMC, as well as nationally recognized seminars and courses to complement local training. As an institution, CCHMC is committed to supporting junior faculty members through internal grants, administrative support, and structured opportunities for faculty networking and education. Dr. Auger is a member of the Division of Hospital Medicine at CCHMC. This division is among the most research-oriented pediatric hospital medicine divisions in the country. Dr. Auger receives extensive support including exceptional mentors (above), computers and software, biostatistical advisors, data management support, clinical research coordinators, grants management support, a cadre of other junior faculty researchers, and discretionary funds. Dr. Auger is also a member of CCHMC's James M. Anderson Center for Health Systems Excellence, a nationally-renowned research division that focuses on assessing and improving pediatric health care delivery. Summary: This innovative research proposal will result in the first validated pediatric risk prediction tool for unplanned readmission. The proposal aligns well with AHRQ's priority areas of safety and quality. It focuses on AHRQ priority populations including children and children with disabilities. Dr. Auger's research and clinical training, prior research experiences, and outstanding mentorship team make her ideally suited to pursue this line of research. This award will provide her with the research training needed to be successful in the future development of interventions to prevent readmission. Furthermore, this career development award will facilitate Dr. Auger's development into a nationally-recognized independent investigator in pediatric hospital medicine.