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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
1K08HS023683-01
Application #
8805722
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Anderson, Kay
Project Start
2014-09-30
Project End
2018-09-29
Budget Start
2014-09-30
Budget End
2015-09-29
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
New York University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
New York
State
NY
Country
United States
Zip Code
10016
Blecker, Saul; Herrin, Jeph; Kwon, Ji Young et al. (2018) Effect of Hospital Readmission Reduction on Patients at Low, Medium, and High Risk of Readmission in the Medicare Population. J Hosp Med 13:537-543
Blecker, Saul; Sontag, David; Horwitz, Leora I et al. (2018) Early Identification of Patients With Acute Decompensated Heart Failure. J Card Fail 24:357-362
Blecker, Saul; Kwon, Ji Young; Herrin, Jeph et al. (2018) Seasonal Variation in Readmission Risk for Patients Hospitalized with Cardiopulmonary Conditions. J Gen Intern Med 33:599-601
Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B et al. (2017) Early Lessons on Bundled Payment at an Academic Medical Center. J Am Acad Orthop Surg 25:654-663
Blecker, Saul; Meisel, Talia; Dickson, Victoria Vaughan et al. (2017) ""We're Almost Guests in Their Clinical Care"": Inpatient Provider Attitudes Toward Chronic Disease Management. J Hosp Med 12:162-167
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
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
Blecker, Saul; Gavin, Nicholas P; Park, Hannah et al. (2016) Observation Units as Substitutes for Hospitalization or Home Discharge. Ann Emerg Med 67:706-713.e2
Durstenfeld, Matthew S; Ogedegbe, Olugbenga; Katz, Stuart D et al. (2016) Racial and Ethnic Differences in Heart Failure Readmissions and Mortality in a Large Municipal Healthcare System. JACC Heart Fail 4:885-893
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

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