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: 10213128
• 负责人: Himali Weerahandi
• 金额: $ 19.33万
• 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 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10213128
• 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; 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.

项目总结/摘要 本申请的主要目的是支持Weerahandi博士的职业发展， 指导研究员成为独立的临床研究员，专注于通过以下方式改善患者结局： 针对护理协调的不良过渡和失败。这个K23奖将为她提供支持， 需要实现以下目标：（1）发展混合方法研究的技能，（2）进行 使用大型数据库进行调查，以确定系统级干预领域，以改善过渡，（3） 在卫生服务研究中实施先进的生物统计模型，（4）成为卫生服务专家 心力衰竭（HF）患者急性期后管理的研究。为了实现这些目标，她 组建了一个多学科指导小组。她的主要导师霍维茨医生是一位有成就的临床医生 研究人员专注于改善医疗保健系统。她的共同导师琼斯博士是一位统计学家， 指导维拉汉迪博士接受高级生存分析方法的培训她的科学顾问包括博士。 Boxer是一位在专业护理机构HF管理领域经验丰富的卫生服务研究人员 (SNF)以及多德森博士，一位老年心脏病专家，他将监督维拉汉迪博士在老年心力衰竭方面的培训， 管理 在HF患者中，出院至SNF是常见的，HF后五分之一的医疗保险受益人发生这种情况 入院尽管普遍出院到SNF，很少有人知道从SNF到家的过渡。 虽然研究已经检查了从医院到家庭的过渡，但从SNF的具体过渡的质量 HF患者的回家时间不详。理想情况下，过渡性护理应在患者出院时进行 从SNF到家然而，这种做法在何种程度上和以何种质量执行，还不确定。的 本申请的研究目的是更好地表征从 HF住院后SNF回家。Weerahandi博士将进行一项融合的混合方法研究， 通过访谈工作人员、患者和护理人员，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 改善这种转变的系统级干预，可能导致再入院的患者级因素， 医疗保险人群的死亡率也必须考虑在内，特别是虚弱和认知程度 损伤根据她的初步数据，她将使用医疗保险数据进行回顾性队列研究 与最小数据集相关联，以确定虚弱评分或认知障碍程度是否相关 HF住院后从SNF过渡到家庭后发生不良事件（目的2）。本研究 该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，鲍克瑟博士的 NHLBI资助的研究小组和纽约大学CTSA。