Identifying Effective Strategies to Improve Participation in Cardiac Rehabilitation after an Acute Cardiac Hospitalization

项目摘要 这是一个重新提交的K23奖奎因包，医学博士，理学硕士，一个委员会认证的心脏病专家， 塔夫茨大学医学院（TUSM）助理教授。包博士是总部设在该中心， 护理质量研究（CQCR），位于马萨诸塞州斯普林菲尔德的Baystate医学中心（BMC）。帕克医生 重点是提高急性心肌梗死后合格患者的心脏康复（CR）参与率。 心脏病住院他的长期目标是成为一个独立的心血管实施 物理学家兼科学家他的近期目标是获得指导研究补助金，成功完成他的 具体目标，并从大学获得传播和实施方面的额外培训， 马萨诸塞州医学院。他之前作为心脏病专家和预防心脏病专家的培训，以及 作为他的硕士学位和塔夫茨KL2奖，将帮助他实现这些目标。帕克博士已经召集了 一个导师团队，在拟议的工作和帮助初级教师过渡到独立的专业知识。 他的主要导师是Peter Lindenauer博士，他是比较经济学领域的全国公认的专家。 有效性研究和实施科学。他的共同导师包括菲利普Ades博士（CR专家）， Kathleen Mazor（心理测量师）和Penelope Pekow博士（生物统计学家）。帕克博士将拥有 BMC、TUSM和UMMS的资源。CQCR（由Lindenauer博士指导）将提供指导， 生物统计学和行政支持，以及具有类似兴趣的初级教师的同行小组。 该研究提案旨在回答以下问题：“哪些因素和策略使 医院实现高风险调整门诊CR参与率？”尽管有强大的健康益处， 强烈的社会指南建议患者在急性心脏病住院后接受CR， 在全国范围内，只有20%的患者曾经参加过CR。因为绝大多数临床事件 使患者有资格获得CR导致住院，鼓励CR参与的合理场所是在 患者住院。然而，很少有人知道医院的护理过程如何影响CR 出院后参加。在目标1中，使用住院医疗保险受益人的数据，我们将 计算医院特定的CR风险标准化率，以评估医院在促进CR方面所发挥的作用 参与的在第二个目标中，我们将进行一次全国性的医院调查，以确定相关因素 以及与较高风险标准化CR参与率相关的策略。在目标3中，我们将使用 高绩效医院的定性方法，以探索有助于 这些医院有效地促进了CR参与。这些项目将产生知识和数据， 未来的R01需要，我们计划进行一项随机对照试验，以测试多方面的 干预，以提高出院后CR的参与率。

PROJECT SUMMARY This is a resubmission for a K23 award for Quinn Pack, MD, MSc, a board-certified cardiologist and Assistant Professor at the Tufts University School of Medicine (TUSM). Dr. Pack is based in the Center for Quality of Care Research (CQCR) at Baystate Medical Center (BMC) in Springfield, Massachusetts. Dr. Pack's focus is on increasing participation rates in cardiac rehabilitation (CR) for eligible patients after an acute cardiac hospitalization. His long-term goal is to become an independent cardiovascular implementation physician-scientist. His immediate goals are to obtain a mentored research grant, successfully complete his specific aims, and obtain additional training in dissemination and implementation from the University of Massachusetts Medical School (UMMS). His prior training as a cardiologist and preventive cardiologist, as well as his Master's Degree and Tufts KL2 award, will help him to accomplish these goals. Dr. Pack has assembled a mentorship team with expertise in the proposed work and in helping junior faculty transition to independence. His Primary Mentor is Dr. Peter Lindenauer, a nationally recognized expert in the field of comparative effectiveness research and implementation science. His Co-Mentors include Dr. Phillip Ades (CR expert), Dr. Kathleen Mazor (psychometrician), and Dr. Penelope Pekow (biostatistician). Dr. Pack will have full access to the resources of BMC, TUSM, and UMMS. The CQCR (directed by Dr. Lindenauer) will provide mentoring, biostatistical, and administrative support as well as a peer group of junior faculty with similar interests. The research proposal aims to answer the question: “What are the factors and strategies that enable hospitals to achieve high risk-adjusted outpatient CR participation rates?” Despite powerful health benefits and strong society guideline recommendations for patients to attend CR after an acute cardiac hospitalization, nationally, as few as 20% of patients ever participate in CR. Because the vast majority of clinical events that qualify a patient for CR result in hospitalization, a logical place to encourage CR participation is during the patient's hospitalization. However, little is known about how hospital processes of care influence CR participation after hospital discharge. In Aim 1, using data from hospitalized Medicare beneficiaries, we will compute hospital-specific risk-standardized rates of CR to evaluate the role that hospitals play in facilitating CR participation. In the second Aim, we will perform a national survey of hospitals to identify the contextual factors and strategies associated with higher risk-standardized rates of CR participation. In Aim 3, we will use qualitative methods at high performing hospitals to explore the strategies and implementation factors that help these hospitals effectively promote CR participation. These projects will generate the knowledge and data needed for a future R01, in which we plan to conduct a randomized controlled trial to test a multifaceted intervention in order to increase rates of participation in CR following hospital discharge.