Candidate: My long-term goal is to become an independent research investigator in the evaluation of health policy-related issues in rehabilitation and post-acute care by developing expertise in health services research methods. The four objectives for this K01 proposal directly support my long-term career goals and are to: 1). Understand the usability of Medicare and other administrative claims data; 2). Develop methodological skills to answer clinically relevant research questions; 3). Monitor and comprehend the impact of health policy changes that will be implemented at the post-acute care level (e.g., payment bundling, site neutral payment, IMPACT Act); and 4). Engage in grant writing and external collaboration activities to further my academic career. Mentoring Team: My mentoring team includes senior research investigators experienced in both health services research and rehabilitation outcomes research. The team is comprised of a biostatistician, a rehabilitation research investigator, a critical care medicine physician, and a health economist/health policy evaluation specialist. My mentoring team will guide me in the career development phase (structured coursework, seminars, conferences) and in the research phase (grant writing and collaboration) of this proposal. Research Strategy: The overarching goal of this K01 proposal is to explore the variation in access to post-acute care settings in patients discharged from acute hospitals after stroke, lower extremity fracture, and lower extremity joint replacement.
The specific aims of the proposed study are to:
Aim 1 : Explore variation in access to post-acute care settings and determine the extent to which patient-, facility-, and market-level factors are associated with this variation.
Aim 2 : Compare outcomes between post-acute care settings by developing and testing methods to address selection bias. Primary outcomes include functional status, community discharge, and hospital readmission. This study will be conducted using Medicare data for 2012-2014. The research strategy of this proposal is aligned with my overall career development plan to gain better understanding of post-acute care settings and to develop expertise in health services research and health policy evaluation related to rehabilitation and post- acute care. Using the skills and knowledge I will acquire during this K01, I will submit a NIH R01 to investigate the impact of the health policy changes on the utilization o rehabilitation services and associated outcomes.
Evidence comparing the effectiveness among post-acute settings can be biased in the absence of systematic methodological approaches to examine the factors influencing access to post-acute care settings after acute hospital discharge. This study will develop methods to control for such biases by taking into account factors at the patient-level, provider-level, and market-level. Results from this study will provide a framework aligned with proposed changes for post-acute care.
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