The Intersection of Personalized Medicine and Implementation Science to Improve Healthcare Utilization in Cirrhosis

个性化医疗与实施科学的交叉点提高肝硬化医疗保健利用率

• 批准号: 10613905
• 负责人: Archita P. Desai
• 金额: $ 18.05万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10613905
• 关键词: Admission activity; Algorithms; Biometry; Brain; Calibration; Caregiver support; Caring; Cellular Phone; Chronic Disease; Cirrhosis; Complement; Data; Data Analyses; Data Correlations; Data Sources; Databases; Dementia; Disease Management; Emergency department visit; Equity; Face; Future; Goals; Guidelines; Health; Health Care Reform; Health Technology; Health system; Healthcare; Healthcare Systems; Hospitalization; Individual; Intervention; Liver; Liver diseases; Measures; Medical Records; Mentors; Mentorship; Methodology; Mobile Health Application; Modeling; Outcome Measure; Patient Education; Patient Outcomes Assessments; Patients; Performance; Population; Predictive Factor; Prospective Studies; Prospective cohort; Research; Resources; Risk; Symptoms; Testing; Time; Training; Translating; Vulnerable Populations; big data management; cohort; cost; design; end stage liver disease; evidence base; experience; feasibility testing; health application; health assessment; health care service utilization; health data; high risk; hospital readmission; implementation science; improved; improved outcome; innovation; inpatient service; multidimensional data; novel; patient engagement; patient oriented; patient population; performance tests; personalized medicine; population health; predictive modeling; programs; prospective; readmission rates; risk prediction; risk prediction model; skills; socioeconomics; success; tool

ABSTRACT Management of cirrhosis is resource-intensive and disproportionately contributes a growing burden on healthcare. Inpatient care is a sizeable portion of this burden where nearly 30% of admissions result in a readmission within 30 days. Unfortunately, health system-based interventions successful in reducing readmission rates face important barriers to dissemination. In order for successful health delivery redesign to occur, it is important to target the right patient and deliver a tailored intervention. Precisely segmenting patient populations to identify high utilizers is an important first step. Current readmission prediction models based on traditional medical records data have weak performance in cirrhosis. Instead, our novel preliminary data correlate patient reported outcome measures (PROMs) to future healthcare utilization (HCU). Further, the PI’s mentor has shown that when healthcare systems combine real-time PRO tracking with evidence-based management algorithms and patient-facing health tools, HCU burden can be reduced. Based on these data, this proposal will first test the overarching hypothesis that a combination of EHR-based and non-EHR, patient-centered measures will better identify high utilizers in cirrhosis. Taken a step further, this proposal will also test the hypothesis that successful, scalable models of care can be translated to high-risk cirrhotics through adaptation of a health technology tool. We will test these hypotheses via three aims and a robust training plan. Specific Aim #1 will assess HCU prediction by existing risk models and then utilize a state-wide data source to further refine risk prediction with liver disease-specific and population health data. Specific Aim #2 will further calibrate prediction of future HCU using PROMs in a prospective cohort of hospitalized cirrhotics. With the ability to identify a vulnerable group of cirrhotics from SA#s 1-2, Specific Aim #3 will build on the co-mentor’s (Dr. Boustani) success in improving HCU in dementia populations by adapting Brain Care Notes, a mobile phone health application designed to support real-time symptom tracking, care-giver support and engagement to reduce HCU in those with cirrhosis. Further, while completing these aims, the PI will accomplish 3 interdisciplinary training goals: 1) develop advanced biostatistical and big data management and analysis skills; 2) acquire experience in methodologies needed for the study of PROMs; 3) gain expertise in healthcare implementation science research all under the guidance of a robust mentorship team led by national experts in the proposed fields. Successful completion of these aims will support the design of a future R01-level intervention that provides innovative, scalable solutions for the chronic disease management in cirrhosis.

摘要

项目成果

Trends in Racial and Ethnic Disparities in the Receipt of Lifesaving Procedures for Hospitalized Patients With Decompensated Cirrhosis in the US, 2009-2018.

• DOI: 10.1001/jamanetworkopen.2023.24539
• 发表时间: 2023-07-03
• 期刊: JAMA network open
• 影响因子: 13.8

Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis.

• DOI: 10.1016/j.cgh.2021.07.032
• 发表时间: 2022-06
• 期刊: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
• 作者: Orman ES;Ghabril MS;Desai AP;Nephew L;Patidar KR;Gao S;Xu C;Chalasani N
• 通讯作者: Chalasani N

Hospital frailty risk score is superior to legacy comorbidity indices for risk adjustment of in-hospital cirrhosis cases.

• DOI: 10.1016/j.jhepr.2023.100955
• 发表时间: 2024-01
• 期刊: JHEP REPORTS
• 影响因子: 8.3
• 作者: Desai, Archita P.;Parvataneni, Swetha;Knapp, Shannon M.;Nephew, Lauren D.;Chalasani, Naga;Ghabril, Marwan S.;Orman, Eric S.
• 通讯作者: Orman, Eric S.

Palliative Care, Patient-Reported Measures, and Outcomes in Hospitalized Patients With Cirrhosis.

• DOI: 10.1016/j.jpainsymman.2022.02.022
• 发表时间: 2022-06
• 期刊: JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
• 影响因子: 4.7
• 作者: Orman, Eric S.;Yousef, Andrew;Xu, Chenjia;Shamseddeen, Hani;Johnson, Amy W.;Nephew, Lauren;Ghabril, Marwan;Desai, Archita P.;Patidar, Kavish R.;Chalasani, Naga
• 通讯作者: Chalasani, Naga

Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease.

• DOI: 10.1016/j.amjmed.2021.09.016
• 发表时间: 2022-03
• 期刊: The American journal of medicine
• 作者: Yoder L;Mladenovic A;Pike F;Vuppalanchi R;Hanson H;Corbito L;Desai AP;Chalasani N;Orman ES
• 通讯作者: Orman ES