This K23 Mentored Patient Oriented Research Career Development Award application outlines the training program, plan for career development and program of research for Dr. Ank Nijhawan. Dr. Nijhawans long-term goal is to become an independent investigator in HIV Health Services and Outcomes research.
She aims to achieve this goal through training in prediction modeling using medical informatics, qualitative methods and social/behavioral determinants of health, and intervention design and comparative effectiveness research. Dr. Nijhawan's specific research aims are directly aligned with this training plan as follows: 1) To develop and compare the effectiveness of an EMR-plus prediction model versus an EMR-only model in predicting 30-day readmissions among HIV+ individuals 2) To identify rates, predictors and reasons for potentially preventable readmissions through a detailed chart review and qualitative interviews and 3) To develop and pilot a multi- component intervention targeting preventable causes of readmission in HIV inpatients predicted to be at high risk for readmission.
Aim 1 will build an essential tool to stratify patients by their risk fo readmission.
Aim 2 will use mixed methods to understand why HIV-infected patients are being readmitted, whether or not the readmissions are preventable and how readmissions may be prevented in the future.
Aim 3 incorporates what is learned in Aims 1 and 2 in order to design and implement a targeted pilot intervention with relevant components being delivered by the members of a multidisciplinary team. Building upon the skills and data acquired through the proposed training and research project, Dr. Nijhawan will apply for an R21 grant focused on prospective validation of the readmissions prediction model in an external dataset during year 2 and for an R01 grant of a larger scale readmissions intervention in year 4. This proposal focuses on the intersection of two important national healthcare directives, the National HIV/AIDS strategy (NHAS) and the Affordable Care Act s (ACA) hospital readmission reduction program. The NHAS emphasizes increasing access to care, optimizing health outcomes for people living with HIV and reducing HIV-related health disparities and the ACA utilizes 30-day hospital readmissions as a metric for quality of care. This research proposal represents a unique overlap in these two recent federal policies which has not previously been examined and has the potential to impact an underserved, vulnerable population. Through improving our ability to predict, understand and reduce 30-day readmissions in HIV patients, we may not only satisfy the ACA readmission reduction program, but we may also come closer to achieving the goals outlined in the NHAS.
This project aims to better predict, understand and reduce 30-day readmissions in HIV-infected patients. Reducing readmissions may translate into improved engagement in HIV care, increased receipt of highly active antiretroviral therapy, higher rates of virologic suppression, reduction in HIV disparities and decreased mortality in HIV patients. Improving our understanding of readmissions in HIV patients therefore has significant implications for health outcomes in a vulnerable population.
|Elliott, Jennifer C; Brincks, Ahnalee M; Feaster, Daniel J et al. (2018) Psychosocial Factors Associated with Problem Drinking Among Substance Users with Poorly Controlled HIV Infection. Alcohol Alcohol 53:603-610|
|Nijhawan, Ank E; Liang, Yuanyuan; Vysyaraju, Kranthi et al. (2017) Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care. AIDS Patient Care STDS 31:213-221|
|de la Flor, Carolina; Porsa, Esmaeil; Nijhawan, Ank E (2017) Opt-out HIV and Hepatitis C Testing at the Dallas County Jail: Uptake, Prevalence, and Demographic Characteristics of Testers. Public Health Rep 132:617-621|
|Raifman, Julia R; Gebo, Kelly A; Mathews, William Christopher et al. (2017) Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004-2014. J Acquir Immune Defic Syndr 76:409-416|
|Monroe, Anne K; Fleishman, John A; Voss, Cindy C et al. (2017) Assessing Antiretroviral Use During Gaps in HIV Primary Care Using Multisite Medicaid Claims and Clinical Data. J Acquir Immune Defic Syndr 76:82-89|
|Agwu, Allison L; Fleishman, John A; Mahiane, Guy et al. (2017) Comparing longitudinal CD4 responses to cART among non-perinatally HIV-infected youth versus adults: Results from the HIVRN Cohort. PLoS One 12:e0171125|
|Lee, Lana; Yehia, Baligh R; Gaur, Aditya H et al. (2016) The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth. AIDS Patient Care STDS 30:170-7|
|Farmer, Charles; Yehia, Baligh R; Fleishman, John A et al. (2016) Factors Associated With Retention Among Non-Perinatally HIV-Infected Youth in the HIV Research Network. J Pediatric Infect Dis Soc 5:39-46|
|Nijhawan, Ank E (2016) Infectious Diseases and the Criminal Justice System. Am J Med Sci 352:399-407|
|Nijhawan, Ank E; Iroh, Princess A; Brown, Larry S et al. (2016) Cost analysis of tuberculin skin test and the QuantiFERON-TB Gold In-tube test for tuberculosis screening in a correctional setting in Dallas, Texas, USA. BMC Infect Dis 16:564|
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