Determinants, Outcomes, and Financial Incentives Associated with Cardiac Rehabilitation Enrollment After Cardiac Surgery

项目总结/摘要 候选人：Michael P. Thompson博士是一位流行病学家、卫生服务研究员和教师。 他是密歇根大学心脏外科系的成员。他的长期职业目标是 开展有影响力的、重要的和创新的研究，以提高心脏手术的价值。的 建议的K 01奖申请包括职业发展和研究活动所需的5年计划 实现这一职业目标，成为一名成功的独立调查员。 背景：心脏康复（CR）是一种多学科的循证干预， 成果，但尚未得到广泛采用。在心脏手术患者中，临床试验表明， CR可以延长生命，改善心血管功能和生活质量，并防止下游医疗保健 利用率尽管有这一证据，一半的心脏手术患者从未参加过一次CR， 三分之一的CR参加者完成了全部36个推荐的课程。CR入组的差异 在患者、提供者和地理区域中也得到了证实。提高CR入组率是 这对确保其对心脏手术患者的全部潜力至关重要。 研究目标：我的长期目标是提高心脏外科护理的价值。本研究的目的 主要是：（1）确定心脏手术后CR入组的决定因素，（2）测量CR的效果 心脏手术后入组对临床和经济结局的影响，以及（3）估计财务影响 激励心脏手术后CR入组。为了实现这些目标，我们提出了一系列 对来自IMPROVE网络的索赔数据和临床数据的独特组合进行定量分析， 它在五个多中心心血管质量合作机构中分享数据和最佳实践， 9个州的90多家医院（约占美国所有心脏外科项目的10%）。 培训目标：为促进该提案，提出了三个培训目标。(1)更深入 了解心脏外科护理服务。(2)通过深入的比较，获得因果推理技能 有效性和政策评价组成部分。(3)发展执行方面的技能和经验 科学方法 影响：本提案的调查结果将提供必要的证据， 适当扩大和激励心脏手术后的CR入组，这将增加 心脏外科护理。该提案直接响应了AHRQ在以下方面的兴趣：㈠提供证据， 提高卫生服务的可负担性、效率和质量，以及（ii）卫生服务研究，以实现高质量的 重视医疗体系。最重要的是，拟议的研究战略，职业发展计划，导师， 和制度环境将培养我成长为一个独立的卫生服务研究员。

PROJECT SUMMARY/ABSTRACT CANDIDATE: Michael P. Thompson, PhD, is an epidemiologist, health services researcher, and faculty member in the Department of Cardiac Surgery at the University of Michigan. His long-term career goal is to conduct impactful, significant, and innovative research that improves the value of cardiac surgery. The proposed K01 award application includes a 5-year plan for career development and research activities needed to achieve this career goal and become a successful independent investigator. BACKGROUND: Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention that improves outcomes, but has not been widely adopted. Among cardiac surgical patients, clinical trials have demonstrated that CR extends life, improves cardiovascular function and quality of life, and prevents downstream health care utilization. Despite this evidence, half of cardiac surgical patients never attend a single session of CR, and only one-third of CR enrollees finish the entire 36 recommended sessions. Disparities in CR enrollment across have also been demonstrated across patients, providers, and geographic regions. Improving CR enrollment is critical to ensuring its full potential for cardiac surgical patients. RESEARCH AIMS: My long-term goal is to improve the value of cardiac surgical care. The aims of this study are: (1) to identify determinants of CR enrollment after cardiac surgery, (2) to measure the effect of CR enrollment after cardiac surgery on clinical and economic outcomes, and (3) to estimate the impact of financial incentives on CR enrollment after cardiac surgery. In order to achieve these objectives, we propose a series of quantitative analyses on a unique combination of claims data and clinical data from the IMPROVE Network, which shares data and best practices across five multicenter cardiovascular quality collaboratives covering over 90 hospitals in 9 states (~10% of all US cardiac surgical programs). TRAINING AIMS: Three training aims have been proposed to facilitate the proposal. (1) To gain a deeper understanding of cardiac surgical care delivery. (2) To gain causal inference skills with in-depth comparative effectiveness and policy evaluation components. (3) To develop skills and experience in implementation science methods. IMPACT: Findings from this proposal will provide evidence needed to develop the necessary evidence to appropriately expand and incentivize CR enrollment after cardiac surgery, which will increase the value of cardiac surgical care. The proposal is directly responsive to AHRQ’s interest in (i) generating evidence that will increase the affordability, efficiency, and quality of health and (ii) health services research to achieve a high- value healthcare system. Above all, the proposed research strategy, career development plan, mentorship, and institutional environment will cultivate my growth into an independent health services researcher.