Patients with heart failure experience four million hospitalizations per year in the United States. Of these hospitalizations, approximately three-quarters, or three million hospitalizations annually, are for causes other than heart failure. Patients with heart failure who are hospitalized for other causes are at high risk of post- discharge mortality possibly in part because they are less likely to receive guideline recommended care than patients who are hospitalized primarily for heart failure. Health information technology (HIT) has the potential to improve patient care by enhancing clinician compliance with evidence-based guidelines. Specifically, clinical decision support systems (CDSS) have been used to improve care for patients in hospitals, including those hospitalized for heart failure. Despite their utility, CDSSs have not been developed to apply more broadly to patients with heart failure who are hospitalized for other causes. This is clearly a gap for the millions of patients with heart failure who might experience improved outcomes if they were to receive guideline recommended care. The purpose of this study is to develop and test a CDSS for hospitalized patients who have heart failure, regardless of reason for hospitalization. The firt aim is to develop an Electronic Health Record (EHR) based algorithm to identify patients with heart failure using a variety of computational techniques including natural language processing.
The second aim i s to develop a CDSS to support delivery of guideline recommended care to hospitalized patients with heart failure using human computer interaction techniques.
The third aim i s to implement and test the effectiveness of the CDSS on processes of care for patients with heart failure who are hospitalized for other causes. The central hypothesis is that this decision support system will increase adherence to guideline recommended care, ideally improving outcomes as a result. The candidate, Saul Blecker, MD, MHS, is a general internist and clinician investigator at NYU School of Medicine. The candidate proposes a program of career development and training to achieve the following objectives: 1) develop expertise in medical informatics;2) gain skills in human computer interaction;3) develop expertise in implementation research. The candidate's primary mentor, Stuart Katz, MD, MS, is a seasoned mentor and researcher in heart failure. His co-mentor is Gilad Kuperman, MD, PhD, a leader in health information technology and medical informatics. Donna Shelley, MD, MPH, an expert in implementation and effectiveness research, will serve as an additional co-mentor. This mentorship team will work closely together to guide Dr. Blecker toward his research goal of leveraging HIT to improve the quality care for patients with heart failure.
Patients with heart failure are hospitalized three million times annually for other causes. These hospitalizations are associated with poor quality of care and high morbidity and mortality. We propose to leverage health information technology to improve outcomes for these patients by creating a novel system of reminders to ensure that hospitalized patients with heart failure receive guideline recommended care.
|Blecker, Saul; Johnson, Norman J; Altekruse, Sean et al. (2016) Association of Occupation as a Physician With Likelihood of Dying in a Hospital. JAMA 315:301-3|
|Blecker, Saul; Gavin, Nicholas P; Park, Hannah et al. (2016) Observation Units as Substitutes for Hospitalization orÂ HomeÂ Discharge. Ann Emerg Med 67:706-713.e2|
|Ladapo, Joseph A; Blecker, Saul; Douglas, Pamela S (2016) Appropriateness of cardiac stress test use among primary care physicians and cardiologists in the United States. Int J Cardiol 203:584-6|
|Jubelt, Lindsay E; Goldfeld, Keith S; Chung, Wei-yi et al. (2016) Changes in Discharge Location and Readmission Rates Under Medicare Bundled Payment. JAMA Intern Med 176:115-7|
|Bangalore, Sripal; Guo, Yu; Samadashvili, Zaza et al. (2016) Revascularization in Patients With Multivessel Coronary Artery Disease and Severe Left Ventricular Systolic Dysfunction: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. Circulation 133:2132-40|
|Blecker, Saul; Park, Hannah; Katz, Stuart D (2016) Association of HbA1c with hospitalization and mortality among patients with heart failure and diabetes. BMC Cardiovasc Disord 16:99|
|Ladapo, Joseph A; Blecker, Saul; O'Donnell, Michael et al. (2016) Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis. PLoS One 11:e0161153|
|Durstenfeld, Matthew S; Ogedegbe, Olugbenga; Katz, Stuart D et al. (2016) Racial and Ethnic Differences in Heart Failure Readmissions and Mortality in aÂ Large Municipal Healthcare System. JACC Heart Fail 4:885-893|
|Bangalore, Sripal; Guo, Yu; Samadashvili, Zaza et al. (2015) Revascularization in Patients With Multivessel Coronary Artery Disease and Chronic Kidney Disease: Everolimus-Eluting Stents Versus Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol 66:1209-20|
|Blecker, Saul; Goldfeld, Keith; Park, Hannah et al. (2015) Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study. J Gen Intern Med 30:1657-64|
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