Dr. Jersey Chen is an assistant professor of cardiology at Yale University. His goal is to become an independent clinician scientist focused on applying rigorous research methods to improving the quality and efficiency of cardiovascular care in our health system. To accomplish this goal, he will enroll in courses pertaining to advanced statistical methods in hierarchical general linear modeling and instrumental variables analysis, receive structured mentoring by senior investigators, and develop research regarding geographic variation in the use of imaging associated with stress testing and their relationship to clinical outcomes and costs. This research proposal seeks to provide policymakers with a better understanding of contemporary geographic variation in the use of imaging with stress testing and its relationship with patient outcomes and societal costs. There has been substantial growth in the volume and cost burden of cardiovascular imaging studies, in particular imaging associated with stress testing. Studies suggest that imaging stress tests are often inappropriately ordered in the outpatient setting. However, there is limited data quantifying the extent of geographic variation in the use of imaging with stress testing in contemporary clinical practice. In addition, the clinical and non-clinical factors associated with regional differences are not well understood. Whether regions with higher use of imaging with stress testing have better outcomes is unknown;however, higher use of imaging is almost certainly to be strongly associated with increased costs. Geographic variation presents an opportunity for a comparative effectiveness study to examine how imaging intensity impacts clinical and financial outcomes. This research speaks directly to Agency for Health Care Research and Quality's goal of improving quality and efficiency in our health care system.
The specific aims are to: 1) quantify geographic variations in the use of imaging with stress testing for outpatients;2) identify clinical and non-clinical factors associated with the use of imaging with stress testing;and 3) determine how imaging with stress testing is associated with clinical and financial outcomes. This proposed project and the career development plan will provide Dr. Chen a foundation for a successful career as an independent investigator in cardiovascular outcomes research. Understanding whether differences in use of imaging with stress testing across geographic regions are associated with differences in patient outcomes or costs can help improve effectiveness and efficiency in our health care system.

Public Health Relevance

Understanding whether differences in use of imaging with stress testing across geographic regions are associated with differences in patient outcomes or costs can help improve effectiveness and efficiency in our health care system.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HS018781-05
Application #
8616749
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
Project Start
2010-04-01
Project End
2015-01-31
Budget Start
2014-02-01
Budget End
2015-01-31
Support Year
5
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
City
Los Angeles
State
CA
Country
United States
Zip Code
90027
Goldsweig, Andrew M; Reid, Kimberly J; Gosch, Kensey et al. (2014) Contemporary use of dual antiplatelet therapy for preventing cardiovascular events. Am J Manag Care 20:659-65
Chaudhry, Sarwat I; Khan, Rabeea F; Chen, Jersey et al. (2014) National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010. J Am Heart Assoc 3:e001197
Ezaz, Ghideon; Long, Jessica B; Gross, Cary P et al. (2014) Risk prediction model for heart failure and cardiomyopathy after adjuvant trastuzumab therapy for breast cancer. J Am Heart Assoc 3:e000472
Chen, Jersey; Dharmarajan, Kumar; Wang, Yongfei et al. (2013) National trends in heart failure hospital stay rates, 2001 to 2009. J Am Coll Cardiol 61:1078-88
Krumholz, Harlan M; Lin, Zhenqiu; Keenan, Patricia S et al. (2013) Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA 309:587-93
Chen, Jersey; Ross, Joseph S; Carlson, Melissa D A et al. (2012) Skilled nursing facility referral and hospital readmission rates after heart failure or myocardial infarction. Am J Med 125:100.e1-9
Chen, Jersey; Fazel, Reza; Ross, Joseph S et al. (2011) Do imaging studies performed in physician offices increase downstream utilization?: an empiric analysis of cardiac stress testing with imaging. JACC Cardiovasc Imaging 4:630-7
Dorfman, Adam L; Fazel, Reza; Einstein, Andrew J et al. (2011) Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med 165:458-64
Chen, Jersey; Normand, Sharon-Lise T; Wang, Yun et al. (2011) National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008. JAMA 306:1669-78
Chen, Jersey; Einstein, Andrew J; Fazel, Reza et al. (2010) Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: a population-based analysis. J Am Coll Cardiol 56:702-11