Characteristics of Transitions from Skilled Nursing Facility to Home Following Heart Failure Hospitalization

心力衰竭住院后从专业护理机构过渡到家庭的特点

• 批准号: 9980993
• 负责人: Himali Weerahandi
• 金额: $ 18.15万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980993
• 关键词: Acute; Admission activity; Adverse event; Affect; Area; Biometry; Care given by nurses; Caregivers; Caring; Cessation of life; Characteristics; Continuity of Patient Care; Data; Data Set; Databases; Diet; Elderly; Elements; Failure; Funding; Goals; Hand; Health Services; Health Services Research; Healthcare; Healthcare Systems; Heart failure; Home environment; Hospitalization; Hospitals; Impaired cognition; Instruction; Intervention; Interview; Investigation; Length of Stay; Link; Medicare; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Modeling; Monitor; National Heart, Lung, and Blood Institute; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physicians; Population; Prevalence; Primary Health Care; Process; Provider; Research; Research Design; Research Methodology; Research Personnel; Resources; Retrospective cohort study; Skilled Nursing Facilities; Supervision; Survival Analysis; System; Testing; Time; Training; United States Agency for Healthcare Research and Quality; Work; acute care; beneficiary; care coordination; career; career development; cost; design; experience; frailty; health care settings; hospital readmission; improved; improved functioning; innovation; mortality; multidisciplinary; skills; success

PROJECT SUMMARY/ABSTRACT The primary objective of this application is to support Dr. Weerahandi's career development from a mentored researcher to an independent clinician-investigator focused on improving patient outcomes by targeting poor transitions and failures of care coordination. This K23 award will provide her with the support needed to accomplish the following goals: (1) to develop skills in mixed methods research, (2) to conduct investigations using large databases to identify systems level areas for intervention to improve transitions, (3) to implement advanced biostatistical models in health services research, (4) to become an expert in health services research on the post-acute management of heart failure (HF) patients. To achieve these goals, she has assembled a multidisciplinary mentoring team. Dr. Horwitz, her primary mentor, is an accomplished clinician- investigator focused on improving healthcare systems. Dr. Jones, her co-mentor, is a statistician who will supervise Dr. Weerahandi's training in advanced survival analyses methods. Her scientific advisors include Dr. Boxer, an experienced health services researcher in the area of HF management in skilled nursing facilities (SNF) and Dr. Dodson, a geriatric cardiologist who will oversee Dr. Weerahandi's training in geriatric HF management. Discharge to SNF is common in HF patients, occurring in 1 in 5 Medicare beneficiaries after HF admission. Despite the prevalence of discharge to SNF, little is known about the transition from SNF to home. While studies have examined the transition from hospital to home, the quality of the specific transition from SNF to home for patients with HF is unknown. Ideally, transitional care should occur when patients are discharged from SNF to home. Yet it is uncertain to what degree and with what quality such practices are performed. The research objective of this application is to better characterize discharge process quality during the transition from SNF to home after a HF hospitalization. Dr. Weerahandi will conduct a convergent mixed-methods study to assess discharge process quality from SNF to home by interviewing staff, patients, and caregivers; and examining discharge instructions elements (Aim 1). While Dr. Weerahandi's long term goal is to create effective systems level interventions to improve this transition, patient level factors that may drive readmission and mortality in Medicare populations must also be accounted for, particularly degree of frailty and cognitive impairment. Informed by her preliminary data, she will conduct a retrospective cohort study using Medicare data linked with the Minimum Dataset to determine if frailty score or degree of cognitive impairment are associated with adverse events following the transition from SNF to home after HF hospitalization (Aim 2). This research plan takes advantage of existing resources including Dr. Horwitz's AHRQ- funded research group, Dr. Boxer's NHLBI-funded research group and the NYU CTSA.

项目摘要/摘要 此应用程序的主要目标是支持Weerahandi博士的职业发展 指导研究员为独立临床医生兼调查员，专注于通过以下方式改善患者结局 针对不良过渡和护理协调失败。这个K23奖将为她提供支持 需要完成以下目标：(1)培养混合方法研究的技能，(2)进行 使用大型数据库进行调查，以确定需要干预以改进过渡的系统级别区域，(3) 在卫生服务研究中应用先进的生物统计模型；(4)成为卫生服务专家 心力衰竭患者的急性后处理研究。为了实现这些目标，她有 组建了一个多学科的指导团队。霍维茨博士，她的主要导师，是一位有成就的临床医生- 调查人员将重点放在改善医疗体系上。琼斯博士，她的共同导师，是一名统计学家，他将 监督Weerahandi博士在高级生存分析方法方面的培训。她的科学顾问包括Dr。 博克瑟，熟练护理机构心力衰竭管理领域的经验丰富的卫生服务研究员 (SNF)和Dodson博士，他是一名老年心脏病专家，将监督Weerahandi博士在老年性心衰方面的培训 管理层。 心力衰竭患者出院至SNF是常见的，每5名医疗保险受益人中就有1人在心力衰竭后发生 入场。尽管出院到SNF的情况很普遍，但对从SNF到家庭的过渡知之甚少。 虽然研究已经检查了从医院到家庭的过渡，但从SNF的特定过渡的质量 对于心力衰竭患者来说，回家还不得而知。理想情况下，过渡期护理应在病人出院时进行。 从三军到家。然而，目前还不确定这些做法在多大程度上和以什么质量进行。这个 此应用程序的研究目标是更好地表征从 在接受心衰住院治疗后，三氟化钠回到了家。Weerahandi博士将进行一项融合的混合方法研究 通过采访工作人员、患者和照顾者，评估从SNF到家庭的出院过程质量；以及 检查出院指示要素(目标1)。虽然Weerahandi博士的长期目标是创造有效的 系统层面的干预措施，以改善这一过渡，患者层面的因素，可能会推动再次住院和 还必须考虑医疗保险人群的死亡率，特别是脆弱程度和认知能力 减损。根据她的初步数据，她将使用医疗保险数据进行一项回溯性队列研究 与最小数据集相关联，以确定是否与认知障碍的脆弱分数或程度相关 心力衰竭住院后从SNF过渡到家庭后的不良事件(目标2)。这项研究 计划利用了现有的资源，包括霍维茨博士的AHRQ资助的研究小组，Boxer博士的 NHLBI资助的研究小组和纽约大学CTSA。