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

与 ERCP 术后结果相关的多层次因素评估

• 批准号: 10591340
• 负责人: Anna Tavakkoli
• 金额: $ 16.03万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-15 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591340
• 关键词: Acceleration; Address; Adverse event; Award; Caregivers; Caring; Case Mixes; Clinical; Complication; Data; Data Set; Decision Analysis; Development; Digestive System Disorders; Disease; Educational Intervention; Endoscopic Retrograde Cholangiopancreatography; Endoscopy; Ensure; Environment; Equipment; Evaluation; Evidence based intervention; Expenditure; Facilities and Administrative Costs; Financial Hardship; Foundations; Future; Gastroenterologist; Goals; Health Care Costs; Health Services Research; Health system; Hospitals; Incidence; Inpatients; Intervention; Interview; Liver diseases; Logistic Regressions; Measurable; Measures; Medicare; Mentors; Modeling; Morbidity - disease rate; Outcome; Outpatients; Pancreatitis; Patient Care; Patient-Focused Outcomes; Patients; Phase; Physicians; Policies; Policy Maker; Population Study; Procedures; Productivity; Prospective cohort; Provider; Reporting; Research; Research Personnel; Resources; Sample Size; Shapes; Societies; Statistical Data Interpretation; Statistical Methods; Surveys; System; Texas; Training; United States; Universities; Variant; Work; beneficiary; care costs; career; career development; cohort; comorbidity; complex data; cost; cost effectiveness; demographics; economic evaluation; experience; health care service utilization; health economics; high risk; improved; medical specialties; multilevel analysis; productivity loss; prospective; risk mitigation; sex; success

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.

项目总结/摘要 这个K23提案将完成安娜塔瓦科利，医学博士，理学硕士的培训，对她的长期职业目标， 成为独立的临床研究者和先进内窥镜的领导者。塔瓦科利医生是一位 得克萨斯大学西南分校消化和肝脏疾病部的内镜医师 在卫生服务研究原则方面接受过硕士培训。这个提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，开发前瞻性的 患者队列和UTSW丰富的培训环境，以提高我们对ERCP结果的理解， 整个美国的成本。这项研究将在她的主要导师的指导下完成， 阿米特湾Singal医学博士、理学硕士和共同导师，B。Joseph Elmunzer医学博士，理学硕士，计划导师 战略和医生-调查员咨询委员会的额外投入。五年计划包括正式 课程作业、专业发展和指导研究，以及确定的里程碑，以确保生产力 成功过渡到独立。这项研究有三个具体目标： · AIM 1描述患者、提供者和系统级协变量的变化，并确定其特征， ERCP术后结果。 · AIM 2a描述ERCP术后30天医疗保健利用率的变化，Medicare 美国卫生系统的支出和支出驱动因素。 · AIM 2b列举与ERCP术后不良事件相关的自付费用和间接费用。 · AIM 3模拟潜在干预策略对改善ERCP术后胰腺炎的影响。 为了完成这些高层次的目标，Tavakkoli博士还将（1）描述ERCP术后的变化 医疗保险受益人之间的结果;（2）确定关键的患者，提供者和系统层面的相关性 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)表征医疗保健利用率，并与利用率变化相关，因为它涉及 ERCP后结局;（5）通过直接成本来描述与ERCP后不良事件相关的间接成本 患者接触;（6）利用决策分析模型来了解各种干预措施的临床影响 策略，如选择性转诊到高容量内镜医生，可能会对ERCP术后的发生率产生影响。 胰腺炎这项工作将建立一个R 01提案，重点是：1）建立一个多中心前瞻性队列， 确定与ERCP后不良事件相关的细粒度临床因素; 2）评估患者和提供者 干预策略的接受程度; 3）从我们的决策分析来看，干预策略的成本效益 模型除了建立一个项目研究的基础，以改善内窥镜护理， 该提案将支持和加速Tavakkoli博士的职业发展活动， 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。