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: 10628861
• 负责人: Himali Weerahandi
• 金额: $ 18.65万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10628861
• 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.

项目概要/摘要 此应用程序的主要目标是支持 Weerahandi 博士的职业发展 指导研究人员到一位独立的临床医生研究员，重点是通过以下方式改善患者的治疗结果 针对不良过渡和护理协调失败。这个K23奖项将为她提供支持 需要实现以下目标：（1）培养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转型，（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 组建了一支多学科的指导团队。她的主要导师霍维茨博士是一位卓有成就的临床医生 - 调查员专注于改善医疗保健系统。她的合作导师琼斯博士是一位统计学家，他会 监督 Weerahandi 博士的高级生存分析方法培训。她的科学顾问包括博士。 Boxer，熟练护理机构心力衰竭管理领域经验丰富的健康服务研究员 (SNF) 和老年心脏病专家 Dodson 博士将监督 Weerahandi 博士在老年心力衰竭方面的培训 管理。 心力衰竭患者出院至 SNF 很常见，心力衰竭后五分之一的医疗保险受益人中就会出现这种情况 入场。尽管出院到 SNF 的情况很普遍，但人们对从 SNF 到家庭的过渡却知之甚少。 虽然研究考察了从医院到家庭的过渡，但从 SNF 的具体过渡的质量 心力衰竭患者是否回家尚不清楚。理想情况下，过渡护理应在患者出院时进行 从 SNF 到家。然而，尚不确定这些做法的执行程度和质量。这 该应用的研究目标是更好地表征从 心衰住院后 SNF 回家。 Weerahandi 博士将进行一项收敛混合方法研究 通过采访工作人员、患者和护理人员来评估从 SNF 到家庭的出院过程质量；和 检查出院指令要素（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措施、可能导致再入院的患者级因素以及 还必须考虑医疗保险人群的死亡率，特别是虚弱程度和认知能力 损害。根据她的初步数据，她将利用医疗保险数据进行回顾性队列研究 与最小数据集关联以确定虚弱分数或认知障碍程度是否相关 心衰住院后从 SNF 过渡到家庭后出现不良事件（目标 2）。这项研究 该计划利用了现有资源，包括 Horwitz 博士的 AHRQ 资助的研究小组、Boxer 博士的研究小组 NHLBI 资助的研究小组和纽约大学 CTSA。