Functional, Cognitive, and Social Vulnerabilities and Hospital Readmission

描述(由申请者提供)：该职业发展奖将确立加州大学旧金山分校的住院医生Ryan Greysen博士作为临床医生和调查员的地位，专注于影响老年人住院结果的核心老年脆弱性(功能、认知和社会)。这个K23奖项将为Greysen博士提供实现四个目标所需的支持：(1)成为老龄研究中以患者为中心的结果研究专家；(2)阐明脆弱老年人再次入院的风险因素，并了解这些因素直接影响患者/照顾者的机制；(3)通过使用先进的定量和定性技术，发展混合方法研究方面的专业知识；(4)在医院医学和老年医学的交叉领域发展卫生政策方面的领导力。为了实现这些目标，格雷森博士组建了一支多学科的专家团队，涉及老年病学、定量和定性方法以及卫生政策研究。他的主要导师肯尼斯·科文斯基博士在老龄化结果研究方面拥有丰富的经验，并指导初级教职员工成为老龄化研究的独立调查人员。他的共同导师是安德鲁·奥尔巴赫博士和丹尼尔·多汉博士，前者是医院护理质量和实施科学的定量分析专家，后者是卫生和卫生政策的社会决定因素的定性分析方面的领先专家。 格雷森博士还将受益于两位杰出的科学顾问的专业知识，他们拥有先进生物统计学和混合方法研究方面的专业知识。在老年人的健康发展轨迹中，再次住院是一件常见、昂贵和重要的事件。格雷森博士的研究计划建立在他的初步数据的基础上，以检查功能、认知和社会脆弱性对医疗保险患者重新入院的影响。他将研究这些影响，方法是将具有全国代表性的健康和退休调查(HRS)中有关这些漏洞的数据添加到Medicare索赔数据中，并对Medicare使用的相同分析方法进行建模，以惩罚高于预期的30天再次住院率(Aim1a-c)的医院。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分组分析，以反映这项有争议的医疗保险政策在2012年的最初实施情况(Aim 1D)。格雷森博士会 还对最近从两家医院(一家大型医院)出院的功能、认知和社交脆弱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)在一个城市(目标2)。这一目标将探讨脆弱性直接影响老年人和照顾者从住院中休养的努力并使今后能够针对这些患者采取干预措施的机制。这项研究计划利用了科文斯基博士的老年结果研究小组和HRS-Medicare数据集的加州大学旧金山分校和NIA现有资源。最后，这项研究将形成R01应用的基础，以研究改善住院老年人过渡护理结果的干预措施。

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.