The care of hospitalized patients has evolved markedly in the last decade. Shifts in surgical and medical care to outpatient settings and pressure to reduce costs have increased the acuity of hospitalized patients and the need for improved clinical efficiency and care quality. In part due to these pressures, many hospitals have redesigned their inpatient services so that dedicated inpatient specialists ('hospitalists') provide inpatient care to medical patients. In addition, hospitalists also direct care of patients on non-medical (i.e. surgical) services at many sites. Growth of this new role, termed 'comanagement,' is paralleling that of the hospitalist model, yet its effects are unknown. Implementation of comanagement at UCSF will permit the first rigorous evaluation of comanagement and provide a laboratory for this training award. The proposed course of study will augment the Principal Investigator's (PI) existing skills in outcomes research, cost-effectiveness analysis, and clinical epidemiology with methodology useful in the execution of clinical trials, analysis of complex datasets, and organizational theory as it relates to executing and assessing changes in healthcare systems. This proposal also describes 3 research goals, to be achieved in 2 phases. The first phase will involve derivation of a medical complication risk index to identify high-risk patients. Phase 2 will be centered around a randomized trial of comanagement of at-risk patients identified by the index, and will examine comanagement's impact on patient safety (as measured by medical complication rates), utilization, and patient satisfaction. The third goal, to also take place in Phase 2, involves refinement of data collection strategies for use in future multicenter studies. Thus, this award will allow the applicant to develop new skills important to his clinical and research career, and provide the setting in which he will become an independent investigator in perioperative medicine outcomes research and organizational methods to improve perioperative patient safety.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HS011416-05
Application #
7105548
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
Project Start
2002-09-30
Project End
2008-03-29
Budget Start
2006-09-30
Budget End
2008-03-29
Support Year
5
Fiscal Year
2006
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Auerbach, Andrew D; Sehgal, Niraj L; Blegen, Mary A et al. (2012) Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project. BMJ Qual Saf 21:118-26
Vasilevskis, Eduard E; Knebel, R Justin; Dudley, R Adams et al. (2010) Cross-sectional analysis of hospitalist prevalence and quality of care in California. J Hosp Med 5:200-7
Karliner, Leah S; Kim, Sue E; Meltzer, David O et al. (2010) Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med 5:276-82
Bozic, Kevin J; Vail, Thomas P; Pekow, Penelope S et al. (2010) Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients? J Arthroplasty 25:1053-60
Auerbach, Andrew D; Hilton, Joan F; Maselli, Judith et al. (2010) Case volume, quality of care, and care efficiency in coronary artery bypass surgery. Arch Intern Med 170:1202-8
Gardner, Rebekah L; Almeida, Richard; Maselli, Judith H et al. (2010) Does gender influence emergency department management and outcomes in geriatric abdominal pain? J Emerg Med 39:275-81
Auerbach, Andrew D; Maselli, Judith; Carter, Jonathan et al. (2010) The relationship between case volume, care quality, and outcomes of complex cancer surgery. J Am Coll Surg 211:601-8
Mazotti, Lindsay A; Vidyarthi, Arpana R; Wachter, Robert M et al. (2009) Impact of duty-hour restriction on resident inpatient teaching. J Hosp Med 4:476-80
Flanders, Scott A; Centor, Bob; Weber, Valerie et al. (2009) Challenges and opportunities in academic hospital medicine: report from the academic hospital medicine summit. J Gen Intern Med 24:636-41
Auerbach, Andrew D; Hilton, Joan F; Maselli, Judith et al. (2009) Shop for quality or volume? Volume, quality, and outcomes of coronary artery bypass surgery. Ann Intern Med 150:696-704

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