Predicting Pediatric Readmission: Development of a Validated Risk Prediction Tool

预测儿科再入院：开发经过验证的风险预测工具

• 批准号: 9900743
• 负责人: Katherine Ann Scott Auger
• 金额: $ 14.83万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9900743
• 关键词: Predicting; Pediatric; Readmission; Development; Validated

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.

项目摘要 博士Auger是一名儿科住院医师，其首要职业目标是防止不必要的住院。 项目概述：儿科再入院很常见;然而，临床医生目前没有系统的方法 来预测哪些患者在出院后会因计划外再入院而再次入院。这项建议的目的是 1）确定出院医疗复杂性的标志物，并检查其与再入院的关系; 2） 为单个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：Auger博士是辛辛那提医院医学部儿科助理教授 儿童医院医疗中心（CCHMC）。她完成了两个奖学金： 医院医学和罗伯特伍德约翰逊基金会（RWJF）临床学者计划奖学金， 卫生服务研究。作为RWJF奖学金的一部分，她还完成了健康硕士学位， 医疗保健研究。拟议的K08职业发展计划建立在她的奖学金培训基础上， 早期职业发展，以解决四个需要额外培训的领域，以提高她的轨迹， 成为独立调查员：培训目标1。增加关于高级统计原则的专门知识。 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，本发明还提供了一种方法， 理解层次模型对于未来关注医院结果的研究至关重要。 培训目标2.获得关于健康的社会决定因素的额外培训。社会风险已被证明 影响出院后风险。奥格博士需要在测量社会决定因素方面接受额外的培训 确保在风险预测工具中使用最佳方法来考虑此类风险因素。培训目标3. 获得制定和实施干预措施的技能。奥格博士迄今为止的培训还不包括 实施科学或干预试验。她将需要这两种技能，以促进进一步发展 以及在随后的R奖励期间针对预防再入院的干预措施的测试。培训 目标4.加强学术和专业发展技能。奥格博士将继续培养 我需要通过领导力和写作，审查课程成为一名成功的独立调查员 参加"K俱乐部"，并在国家会议上发言。 导师关系：萨米尔博士S。Shah和Robert S.卡恩和奥格博士的合作伙伴 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 医院到家庭过渡补助金。卡恩博士是健康的社会决定因素方面的专家， 获得R 01级资助，用于研究儿科哮喘再入院的差异。另外两名导师 完整的Auger博士的导师团队：Maria T.布里托和马修·M博士。戴维斯布里托医生是一位 慢性病管理与实施科学方法的专业知识。戴维斯医生是儿科医生 他是西北大学的卫生政策专家，也是美国前首席医疗执行官。 密歇根他是奥格博士在RWJF奖学金期间的奖学金导师，并监督了 这项建议的基础工作，包括为目标1和2获取数据。卡恩，沙阿，布里托医生 在过去的一年里，戴维斯和奥格博士每季度都作为一个导师团队会面，并将继续这样做 在整个颁奖期间，作为职业发展咨询委员会。 环境：预防再次入院是该机构的高度优先事项。拟议的职业发展 该计划利用了辛辛那提大学和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 致力于通过内部补助金，行政支持和结构化支持初级教师 教师网络和教育的机会。Auger博士是医院医学部的成员 在CCHMC。该部门是美国最注重研究的儿科医院医学部门之一。 国家Auger博士获得了广泛的支持，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、拨款管理支持， 一个由其他初级研究人员组成的骨干队伍，以及可自由支配的资金。Auger博士也是CCHMC的成员 James M.安德森卫生系统卓越中心是一个全国知名的研究部门， 重点是评估和改善儿科医疗服务。 这项创新的研究提案将产生第一个经过验证的儿科风险预测工具， 意外再入院该提案与AHRQ的安全和质量优先领域保持一致。它侧重于 AHRQ优先人口，包括儿童和残疾儿童。奥格博士的研究和临床 培训，先前的研究经验，和优秀的导师团队使她非常适合追求这一点 研究路线。该奖项将为她提供未来成功所需的研究培训 制定干预措施，防止再入院。此外，这一职业发展奖将促进 博士奥格的发展成为一个全国公认的独立调查员在儿科医院医学。