Heart Failure Readmissions in Older Adults: A systems Perspective

老年人心力衰竭再入院：系统视角

• 批准号: 8013366
• 负责人: Leora Horwitz
• 金额: $ 14.85万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8013366
• 关键词: Admission activity; Adverse event; Affect; Agreement; Area; Back; Behavior; Cardiac; Caring; Characteristics; Chronic; Clinical; Communication; Communities; Community Physician; Complex; Contracts; Country; Data; Data Collection; Data Set; Databases; Delirium; Deterioration; Development; Elderly; Environment; Etiology; Evaluation; Event; Exhibits; Fee-for-Service Plans; Fees; Foundations; Funding; Future; Goals; Health; Health Care Costs; Healthcare; Healthcare Systems; Heart failure; Home environment; Hospital Referrals; Hospitalization; Hospitals; Housing; Human; Individual; Inpatients; Intervention; Knowledge; Lead; Link; Measurement; Measures; Mediator of activation protein; Medicare claim; Mentors; Mentorship; Morbidity - disease rate; Outcome; Outcomes Research; Outpatients; Patient Education; Patients; Performance; Play; Population; Primary Care Physician; Process; Public Policy; Quality of Care; Relative (related person); Reporting; Research; Research Activity; Research Contracts; Research Personnel; Research Support; Risk; Role; Series; Specialist; System; Systems Analysis; Techniques; Testing; United States Centers for Medicare and Medicaid Services; Variant; Work; age related; bed capacity; career; career development; clinical care; cost; effective intervention; ergonomics; experience; health care delivery; high risk; hospital readmission; hospital utilization; improved; indexing; interest; lens; older patient; patient oriented; patient safety; response; social; systematic review

DESCRIPTION (provided by applicant): One quarter of older patients admitted for heart failure are readmitted within 30 days of discharge, resulting inincreased morbidity for seniors and high healthcare costs. In an effort to reduce the readmission rate, a risk-standardized hospital readmission rate for heart failure is now publicly reported, and health reform proposals include penalties for hospitals with high readmission rates. Yet despite this intense public interest, the phenomenon of readmission is poorly understood, and risk-standardized readmission rates vary widely among hospitals. Since quality of hospital, transitional and post-discharge care plays an important role in readmission risk; we approach this problem from a systems perspective. My long-term goal is to develop a research career dedicated to improving healthcare systems at the local, regional and national level so that they maximize care quality, patient safety, coordination and communication for older patients. The goals of this proposal are to build my skill set in this area, acquire data for hypothesis testing and future interventions, and to expand my mentoring relationships to encompass geriatric and transitional care experts. The specific career development aims are: (1) to build a foundation of geriatric and aging-related knowledge; (2) to develop expertise in quality assessment in multiple domains using a variety of techniques; (3) to gain experience in the use and analysis of Medicare claims data, and in the integration and merging of a diverse group of large datasets; and (4) to develop advanced expertise in organizational behavior, human ergonomics, systems analysis and other techniques necessary for building safe and patient-centered healthcare systems. I will accomplish this through a combination of coursework, mentorship and research activities. The research goal of this proposal is to develop a better understanding of the modifiable healthcare delivery factors that have an impact on readmissions for geriatric patients. The specific research aims are: (1) to compare clinical, transitional, and post-discharge care for older patients with heart failure admitted to hospitals in the top, middle and bottom ten percent of readmission rates nationally; (2) to describe the etiology and preventability of readmissions in patients admitted to these hospitals; (3) to determine the proportion of variation in risk-standardized readmission rates for heart failure attributable to hospital referral region characteristics; and (4) to identify regional characteristics that are associated with readmission rates for older patients admitted with heart failure. My mentorship team includes experts in heart failure readmissions and quality measurement (H. Krumholz, E. Bradley), and an expert in multi-factorial geriatric conditions (M. Tinetti). Relevance: Older patients have a disproportionately high risk of readmission after hospital discharge and are particularly vulnerable to inadequate healthcare systems. This study is intended to identify the areas in which clinicians, hospitals, and the healthcare environment have influence over readmission rates, in order to develop targeted, high-impact interventions to reduce morbidity in older patients after the hospital-to-home transition. PUBLIC HEALTH RELEVANCE: One quarter of patients admitted for heart failure (HF) are readmitted within 30 days of discharge. Since older patients are at high risk for adverse events during hospitalizations, and since re-hospitalizations alone cost the healthcare system over $17 billion a year, it is highly desirable to avoid readmissions by keeping patients healthier. This study is intended to determine what influence clinicians, hospitals, and the broader healthcare environment have over readmission rates, in order to develop targeted, high-impact interventions to help keep older patients with HF safe at home instead of back in the hospital.

描述（由申请人提供）：四分之一因心力衰竭入院的老年患者在出院后 30 天内再次入院，导致老年人发病率增加和医疗费用高昂。为了降低再入院率，现已公开报告心力衰竭风险标准化医院再入院率，医疗改革建议包括对再入院率高的医院进行处罚。然而，尽管公众对此表现出强烈的兴趣，但人们对再入院现象却知之甚少，而且各医院的风险标准化再入院率差异很大。由于医院质量、过渡和出院后护理在再入院风险中起着重要作用；我们从系统的角度来解决这个问题。我的长期目标是发展研究事业，致力于改善地方、区域和国家层面的医疗保健系统，从而最大限度地提高老年患者的护理质量、患者安全、协调和沟通。该提案的目标是建立我在该领域的技能，获取用于假设检验和未来干预的数据，并扩大我的指导关系以涵盖老年和过渡性护理专家。具体职业发展目标是：（1）建立老年病学和老龄相关知识基础； (2) 使用多种技术发展多个领域质量评估的专业知识； (3) 获得医疗保险索赔数据的使用和分析以及不同的大型数据集的整合和合并方面的经验； (4) 发展组织行为、人体工程学、系统分析和其他构建安全和以患者为中心的医疗保健系统所需的技术方面的先进专业知识。我将通过课程作业、指导和研究活动的结合来实现这一目标。该提案的研究目标是更好地了解影响老年患者再入院的可修改的医疗保健提供因素。具体研究目的是： (1) 比较全国再入院率最高、中间和最低 10% 医院收治的老年心力衰竭患者的临床、过渡和出院后护理； (2) 描述这些医院收治的患者再入院的病因和可预防性； (3) 确定由于医院转诊地区特征导致心力衰竭风险标准化再入院率变化的比例； (4) 确定与因心力衰竭入院的老年患者的再入院率相关的区域特征。我的指导团队包括心力衰竭再入院和质量测量方面的专家（H. Krumholz、E. Bradley）和多因素老年疾病方面的专家（M. Tinetti）。相关性：老年患者出院后再次入院的风险极高，并且特别容易受到医疗系统不足的影响。本研究旨在确定临床医生、医院和医疗环境对再入院率有影响的领域，以便制定有针对性的、高影响力的干预措施，以降低老年患者从医院到家庭的过渡后的发病率。 公共卫生相关性：四分之一因心力衰竭 (HF) 入院的患者在出院后 30 天内再次入院。由于老年患者在住院期间发生不良事件的风险很高，而且仅再住院就使医疗保健系统每年花费超过 170 亿美元，因此非常希望通过保持患者健康来避免再入院。本研究旨在确定临床医生、医院和更广泛的医疗环境对再入院率的影响，以便制定有针对性的、高影响力的干预措施，帮助老年心衰患者在家中安全，而不是回到医院。