I am an assistant professor in the Division of Rehabilitation Sciences at the University of Texas Medical Branch in Galveston, Texas. The purpose of this K01 proposal is to provide me with the knowledge, analytical skill, and experience necessary to become a successful investigator. To me, this means I will develop a funded research program that advances the quality of post-acute care for older adults, in particular for those with cognitive impairment, Alzheimer's disease and related dementias. My K01 application is focused on skilled nursing facilities (SNFs) because they are the most frequent post-acute care site for older adults. My training in gerontology has focused on analyzing cognitive data and using large data sets to identify potentially modifiable risk factors for cognitive impairment and dementia. During the K01 period, I will receive training in four areas that build upon my prior training in gerontology and expertise on the epidemiology of dementia: (1) Health characteristics, assessment process, quality outcomes and follow-up needs associated with older adults receiving SNF care; (2) Operational standards and regulatory (decision making) policies of SNFs; (3) Statistical skills for studying post-acute care outcomes using claims data; and (4) Career advancement and leadership development. Training in these areas will include coursework, shadowing interdisciplinary teams in clinical settings, and experiences accessing, managing, and analyzing Medicare files. This training will make me a researcher with a highly-informed view of healthcare policy and clinical context. My training activities have been integrated with a research project in which I will use national Medicare data files (2012-2014) to complete the following specific aims: (A) Evaluate the change in cognitive status during a SNF stay for older adults with impaired cognition on admission; (B) Examine the variation across SNFs in the percentage of patients with impaired cognition on admission whose cognitive status improves during a SNF stay; and (C) Assess the relationship between cognitive status on admission, improvement in cognitive status during a SNF stay, and performance on SNF quality measures. The expected findings of this research can inform clinical interventions that target patient- and facility-level characteristics associated with improved cognitive status. The findings can also inform healthcare policies meant to incentivize nursing homes to provide high-quality post-acute care. Completion of the K01 mentored training and research plans will provide me with the knowledge and skills necessary to develop a program of research that will advance the quality of post-acute care for older adults, in particular for older adults with cognitive impairment, Alzheimer's disease and related dementias.
Many older adults require post-acute care in a skilled nursing facility (SNF) after being discharged from the hospital. Impaired cognition can slow older adults' recovery during a SNF stay and limit the ability to live independently in the community. Understanding the impact of cognitive impairment on outcomes of SNF care can lead to higher-quality post-acute care for older adults.