Predicting Pediatric Readmission: Development of a Validated Risk Prediction Tool

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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.