Functional, Cognitive, and Social Vulnerabilities and Hospital Readmission

描述（由申请人提供）：这个职业发展奖将建立瑞安·格雷森博士，在加州大学，旧金山弗朗西斯科医院作为一个临床研究人员，专注于核心老年脆弱性（功能，认知和社会），影响老年人的医院结果。该K23奖将为Greysen博士提供实现4个目标所需的支持：（1）成为老龄化研究中以患者为导向的专家成果研究员;（2）阐明脆弱老年人再入院的风险因素，并了解这些因素直接影响患者/护理人员的机制;（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领域发展卫生政策的领导能力。为了实现这些目标，Greysen博士组建了一个多学科专家团队，从事老年医学、定量和定性方法以及卫生政策研究。Kenneth Covinsky博士在老龄化结果研究和指导初级教师成为老龄化研究的独立调查员方面拥有丰富的经验。他的共同导师是安德鲁奥尔巴赫博士，医院护理质量和实施科学的定量分析专家，和丹尼尔多汉博士，卫生和卫生政策的社会决定因素的定性分析的领先专家。 博士Greysen还将受益于两位杰出的科学顾问的专业知识，他们在先进的生物统计学和混合方法研究方面具有专业知识。在老年人的健康轨迹中，再次入院是一种常见、昂贵且重要的事件。Greysen博士的研究计划建立在他的初步数据的基础上，以研究功能，认知和社会脆弱性对医疗保险患者再入院的影响。他将通过将来自全国代表性的健康和退休调查（HRS）的有关这些漏洞的数据添加到医疗保险索赔数据中，并对医疗保险用于惩罚医院高于预期的30天再入院率（Aim 1a-c）的相同分析方法进行建模来研究这些影响。为了最大限度地发挥这项研究的直接政策影响，Greysen博士还将对因心力衰竭、心脏病发作或肺炎入院的患者进行亚组分析，以反映2012年这项有争议的医疗保险政策的最初实施情况（目标1d）。格雷森医生会 我还对最近从两家医院（一家大型医院）出院的有功能、认知和社会脆弱性的住院老年人进行深入的定性数据收集和分析。 公立医院和一家大型学术医院）（目标2）。这一目标将探讨脆弱性直接影响老年人和护理人员住院康复的机制，并使未来的干预措施能够针对这些患者。该研究计划利用了Covinsky博士的老年结局研究小组和HRS-Medicare数据集的现有UCSF和NIA资源。最后，这项研究将成为R 01应用的基础，以研究干预措施，改善住院老年人的过渡护理结果。

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.