Candidate: My long-term goal is to become an independent research investigator in the evaluation of health policy-related issues in rehabilitation and post-acute care by developing expertise in health services research methods. The four objectives for this K01 proposal directly support my long-term career goals and are to: 1). Understand the usability of Medicare and other administrative claims data; 2). Develop methodological skills to answer clinically relevant research questions; 3). Monitor and comprehend the impact of health policy changes that will be implemented at the post-acute care level (e.g., payment bundling, site neutral payment, IMPACT Act); and 4). Engage in grant writing and external collaboration activities to further my academic career. Mentoring Team: My mentoring team includes senior research investigators experienced in both health services research and rehabilitation outcomes research. The team is comprised of a biostatistician, a rehabilitation research investigator, a critical care medicine physician, and a health economist/health policy evaluation specialist. My mentoring team will guide me in the career development phase (structured coursework, seminars, conferences) and in the research phase (grant writing and collaboration) of this proposal. Research Strategy: The overarching goal of this K01 proposal is to explore the variation in access to post-acute care settings in patients discharged from acute hospitals after stroke, lower extremity fracture, and lower extremity joint replacement.
The specific aims of the proposed study are to:
Aim 1 : Explore variation in access to post-acute care settings and determine the extent to which patient-, facility-, and market-level factors are associated with this variation.
Aim 2 : Compare outcomes between post-acute care settings by developing and testing methods to address selection bias. Primary outcomes include functional status, community discharge, and hospital readmission. This study will be conducted using Medicare data for 2012-2014. The research strategy of this proposal is aligned with my overall career development plan to gain better understanding of post-acute care settings and to develop expertise in health services research and health policy evaluation related to rehabilitation and post- acute care. Using the skills and knowledge I will acquire during this K01, I will submit a NIH R01 to investigate the impact of the health policy changes on the utilization o rehabilitation services and associated outcomes.

Public Health Relevance

Evidence comparing the effectiveness among post-acute settings can be biased in the absence of systematic methodological approaches to examine the factors influencing access to post-acute care settings after acute hospital discharge. This study will develop methods to control for such biases by taking into account factors at the patient-level, provider-level, and market-level. Results from this study will provide a framework aligned with proposed changes for post-acute care.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01HD086290-02
Application #
9256516
Study Section
National Institute of Child Health and Human Development Initial Review Group (CHHD)
Program Officer
Quatrano, Louis A
Project Start
2016-04-15
Project End
2021-03-31
Budget Start
2017-04-01
Budget End
2018-03-31
Support Year
2
Fiscal Year
2017
Total Cost
Indirect Cost
Name
University of Texas Med Br Galveston
Department
Physical Medicine & Rehab
Type
Sch Allied Health Professions
DUNS #
800771149
City
Galveston
State
TX
Country
United States
Zip Code
77555
Hong, Ickpyo; Karmarkar, Amol; Chan, Winston et al. (2018) Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going From Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation. Am J Phys Med Rehabil 97:636-645
Collins, Diane M; Downer, Brian; Kumar, Amit et al. (2018) Impact of Multiple Chronic Conditions on Activity Limitations Among Older Mexican-American Care Recipients. Prev Chronic Dis 15:E51
Middleton, Addie; Kuo, Yong-Fang; Graham, James E et al. (2018) Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care. J Am Med Dir Assoc 19:896-901
Li, Chih-Ying; Al Snih, Soham; Karmarkar, Amol et al. (2018) Early frailty transition predicts 15-year mortality among nondisabled older Mexican Americans. Ann Epidemiol 28:362-367.e3
Li, Chih-Ying; Karmarkar, Amol; Lin, Yu-Li et al. (2018) Is Profit Status of Inpatient Rehabilitation Facilities Independently Associated With 30-Day Unplanned Hospital Readmission for Medicare Beneficiaries? Arch Phys Med Rehabil 99:598-602.e2
Li, Chih-Ying; Karmarkar, Amol; Adhikari, Deepak et al. (2018) Effects of Age and Sex on Hospital Readmission in Traumatic Brain Injury. Arch Phys Med Rehabil 99:1279-1288.e1
Kumar, Amit; Karmarkar, Amol M; Graham, James E et al. (2017) Comorbidity Indices Versus Function as Potential Predictors of 30-Day Readmission in Older Patients Following Postacute Rehabilitation. J Gerontol A Biol Sci Med Sci 72:223-228
Goodwin, James S; Li, Shuang; Zhou, Jie et al. (2017) Comparison of methods to identify long term care nursing home residence with administrative data. BMC Health Serv Res 17:376
Kumar, Amit; Karmarkar, Amol; Downer, Brian et al. (2017) Current Risk Adjustment and Comorbidity Index Underperformance in Predicting Post-Acute Utilization and Hospital Readmissions After Joint Replacements: Implications for Comprehensive Care for Joint Replacement Model. Arthritis Care Res (Hoboken) 69:1668-1675
Welsh, Rodney Laine; Graham, James E; Karmarkar, Amol M et al. (2017) Effects of Postacute Settings on Readmission Rates and Reasons for Readmission Following Total Knee Arthroplasty. J Am Med Dir Assoc 18:367.e1-367.e10

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