Evaluation of Multi-level factors Associated with post-ERCP Outcomes

项目摘要/摘要 这项K23计划将完成医学博士Anna Tavakkoli的培训，实现她的长期职业目标 成为先进内窥镜领域的独立临床研究员和领导者。塔瓦科利博士是一位先进的 德克萨斯大学西南分校消化和肝病科的内窥镜医生 具有硕士培养的卫生服务研究原理。这项建议是建立在塔瓦科利博士之前 经验，利用先进的统计方法，利用复杂的数据集，开发预期 患者队列，以及UTSW丰富的培训环境，以提高我们对ERCP结果和 整个美国的成本。研究将在她的主要导师的指导下完成， Amit G.Singal MD，MSc和共同导师B.Joseph Elmunzer MD，MSc，以及计划中的导师-The Mentor 战略和来自医生-调查顾问委员会的额外投入。五年计划包括正式的 课程工作、专业发展和有指导的研究，具有明确的里程碑以确保生产率 并成功过渡到独立。这项有指导的研究有3个具体目标： ·目标1描述患者、提供者和系统级别的协变量的变化，并确定 ERCP术后转归。 ·AIM 2a描述ERCP后30天内医疗保健利用率、医疗保险 美国卫生系统的支出和支出驱动因素。 ·AIM 2b列举了与ERCP后不良事件相关的自付费用和间接费用。 ·目的3模拟潜在干预策略对改善ERCP术后胰腺炎的影响。 作为完成这些高水平目标的内在因素，塔瓦科利博士还将(1)描述ERCP术后的变化 医疗保险受益者的结果；(2)确定关键的患者、提供者和系统级别的关联 与ERCP术后结果的变化相关；(3)描述与ERCP相关的医疗保险支出； (4)确定医疗保健利用率的特征，并将导致利用率变化的因素关联起来，因为它与 ERCP术后结果；(5)表征与ERCP术后不良事件相关的间接成本 (6)利用决策分析模型了解各种干预措施对临床的影响 战略，如选择性转诊大容量内窥镜医生的方法，可能会对ERCP后的比率产生影响 胰腺炎。这项工作将建立在R01提案的基础上，重点是：1)建立多中心预期队列，以 确定与ERCP术后不良事件相关的细粒度临床因素；2)评估患者和提供者 接受干预策略；3)从我们的决策分析看干预策略的成本效益 模特。除了为改善内窥镜治疗的程序性研究路线奠定基础之外 这项提案将支持和加速Tavakkoli博士的职业发展活动，使 她成功地进入了她职业生涯的下一个阶段，成为一名独立调查员。

Project Summary/Abstract This K23 proposal will complete Anna Tavakkoli, MD, MSc’s training towards her long-term career goal of becoming an independent clinician investigator and leader in advanced endoscopy. Dr. Tavakkoli is an advanced endoscopist in the Division of Digestive and Liver Diseases at the University of Texas Southwestern (UTSW) with Master’s training in health services research principles. This proposal builds on Dr. Tavakkoli’s prior experience, leveraging advanced statistical methods, utilizing complex datasets, developing a prospective patient cohort, and the rich training environment at UTSW to improve our understanding of ERCP outcomes and costs throughout the United States. The research will be completed under the guidance of her primary mentor, Amit G. Singal MD, MSc, and co-mentor, B. Joseph Elmunzer MD, MSc, with a planned mentor-the-mentor strategy and additional input from an advisory board of physician-investigators. The 5-year plan includes formal coursework, professional development, and mentored research, with defined milestones to ensure productivity and a successful transition to independence. This mentored research has 3 Specific Aims: • AIM 1 Characterize variation in, and identify patient-, provider, and system-level covariates for post-ERCP outcomes. • AIM 2a Characterize 30-day post-ERCP variations in healthcare utilization, Medicare expenditures and drivers of expenditures across US health systems. • AIM 2b Enumerate out-of-pocket and indirect costs associated with post-ERCP adverse events. • AIM 3 Model the impact of potential intervention strategies to improve post-ERCP pancreatitis. Inherent to completing these high-level aims, Dr. Tavakkoli will also (1) characterize variation in post-ERCP outcomes across Medicare beneficiaries; (2) identify key patient-, provider-, and system-level correlates associated with variation in post-ERCP outcomes; (3) characterize Medicare expenditures as it relates to ERCP; (4) characterize healthcare utilization, and correlates that contribute to variations in utilization, as it relates to post-ERCP outcomes; (5) characterize indirect costs associated with post-ERCP adverse events through direct patient contact; (6) utilizing decision analytic modeling to understand the clinical impact that various intervention strategies, such as a selective referral approach to high-volume endoscopists, could have on rates of post-ERCP pancreatitis. This work will build to an R01 proposal focused on: 1) Building a multi-center prospective cohort to identify granular clinical factors associated with post-ERCP adverse events; 2) Evaluating patient and provider acceptance of intervention strategies; 3) Cost-effectiveness of intervention strategies from our decision analytic model. Beyond establishing a foundation for a programmatic line of research to improve endoscopic care for patients, this proposal will support and accelerate the career development activities of Dr. Tavakkoli, allowing her to successfully launch into the next phase of her career as an independent investigator.