Functional, Cognitive, and Social Vulnerabilities and Hospital Readmission

描述（由申请人提供）：该职业发展奖将使加州大学旧金山分校的医院医生Ryan Greysen博士成为一名临床医生-研究者，专注于影响老年人医院结果的核心老年脆弱性（功能，认知和社会）。该K23奖将为格雷森博士提供实现以下四个目标所需的支持：(1)成为衰老研究领域以患者为导向的专家；(2)阐明易受伤害老年人再入院的危险因素，并了解这些因素直接影响患者/护理者的机制；(3)通过使用先进的定量和定性技术发展混合方法研究的专业知识(4)在医院医学和老年医学的交叉点发展卫生政策的领导能力。为了实现这些目标，格雷森博士在老年病学、定量和定性方法以及卫生政策研究方面组建了一个多学科专家团队。他的主要导师Kenneth Covinsky博士在老龄化结果研究方面拥有丰富的经验，并指导初级教师成为老龄化研究的独立研究者。他的共同导师是Andrew Auerbach博士和Daniel Dohan博士，前者是医院护理质量定量分析和实施科学方面的专家，后者是健康和卫生政策的社会决定因素定性分析方面的主要专家。

DESCRIPTION (provided by applicant): This career development award will establish Dr. Ryan Greysen, a hospitalist at the University of California, San Francisco as a clinician-investigator focused on core geriatric vulnerabilities (functional, cognitive, and social) that impact hospital outcomes among older adults. This K23 award will provide Dr. Greysen the support needed to accomplish 4 goals: (1) to become an expert patient-oriented outcomes researcher in aging research; (2) to elucidate risk factors for readmission among vulnerable older adults and understand the mechanisms by which these factors directly impact patients/caregivers; (3) to develop expertise in mixed methods research through use of advanced quantitative and qualitative techniques (4) to develop leadership in health policy at the intersection of hospital medicine and geriatrics. To achieve these goals, Dr. Greysen has assembled an expert multidisciplinary team in geriatrics, quantitative and qualitative methods, and health policy research. His primary mentor, Dr. Kenneth Covinsky, has extensive experience in aging outcomes research and mentoring junior faculty to become independent investigators in aging research. His co-mentors are Dr. Andrew Auerbach, an expert in quantitative analysis of hospital quality of care and implementation science, and Dr. Daniel Dohan, a leading expert in qualitative analysis of social determinants of health and health policy. Dr. Greysen will also benefit from the expertise of two distinguished scientific advisors with expertise in advanced biostatistics and mixed methods research. Hospital readmission is a common, costly, and important event in the health trajectory of older adults. Dr. Greysen's research plan builds on his preliminary data to examine the impact of functional, cognitive, and social vulnerabilities on readmission for Medicare patients. He will study these effects by adding data about these vulnerabilities from the nationally-representative Health and Retirement Survey (HRS) to Medicare claims data and modeling the same analytical approach used by Medicare to penalize hospitals for higher than expected rates of 30-day readmission (Aim1a-c). To maximize the immediate policy impact of this research, Dr. Greysen will also conduct a subgroup analysis of patients admitted with heart failure, heart attack, or pneumonia to mirror the initial implementation of this controversial Medicare policy in 2012 (Aim 1d). Dr. Greysen will also conduct in-depth qualitative data collection and analysis with hospitalized older adults with functional, cognitive, and social vulnerabilities recently discharged from two hospitals (one large public and one large academic hospital) in one city (Aim 2). This aim will explore mechanisms by which vulnerability directly impacts efforts of older adults and caregivers to recuperate from hospitalization and enable future interventions targeting these patients. This research plan leverages existing UCSF and NIA resources of Dr. Covinsky's geriatric outcomes research group and the HRS-Medicare dataset. Finally, this research will form the basis for an R01 application to study interventions to improve outcomes of transition care for hospitalized older adults.