Through a combination of coursework, mentored research, clinical and research seminars, and input from advisors, I am proposing a plan for career development that will enable me to develop skills in patient- oriented clinical research, including advanced statistical analysis and quantitative, qualitative, and mixed research methods, allowing me to gain independence as an investigator, as well as expand my clinical geriatrics knowledge base. My long-term career goals are to improve health and health care for older adults, conducting clinically-relevant research that informs health policy, and to become a successful independent investigator in aging-related research. Measurement of quality and performance has become increasingly important in American healthcare. In July 2007, CMS began publicly reporting outcomes for two common, costly medical conditions: hospital- specific risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) and heart failure (HF). I am proposing a program of inquiry that will employ a mixed methods approach, pairing quantitative and qualitative methods, to be carried out in two phases. In Phase I, using a quasi-experimental design with pneumonia as a comparison group, we will examine whether public reporting of hospital-specific AMI or HF RSMRs is associated with a) lower mortality rates, b) an attempt to """"""""game"""""""" the measures by hospitals, and c) lower mortality rates among certain hospital types. In Phase II, we will characterize how hospital leaders and Medicare beneficiaries and hospital leaders perceive and use publicly-reported outcome measures, as well as explore their responses to findings generated in the Phase I studies. The results from both phases of the project will increase our understanding of the role and effectiveness of public reporting as a strategy for improving health care outcomes among older adults. These projects will serve as a foundation for future independent research focused on improving hospital quality of care for older adults. This application meets the Beeson Career Development Award's objective of expanding clinically-relevant research on aging in the area of clinical management and systems of care for older adults. The studies proposed within this award application will guide policy, inform health care improvement efforts for older adults, clarify the effect of publicly-reporting outcome measures, and address unsettled questions in the field.
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