The overall goal of this K23 proposal is to train Daniel J. Rubin, MD, MSc for a career as an independent investigator in the prediction and prevention of hospital readmission among patients with diabetes. Readmissions within 30 days of discharge (30d readmissions) are a high-priority quality measure and target for cost reduction. Patients with diabetes and cardiovascular disease (CVD) are disproportionately over- represented in 30d readmissions, especially among racial minorities and urban populations. Currently there is no validated method to identify diabetic patients admitted for CVD at the highest risk of 30d readmission, which is a critical prerequisite for targeting limited resources fr reducing readmission risk to those most in need. Furthermore, there are no proven interventions to reduce the risk of 30d readmission specifically among patients with diabetes. Dr. Rubin plans to address these gaps in knowledge with 2 aims, 1) validating and refining a Diabetes Early Readmission Risk Index (DERRI-CVD) for predicting 30d readmission risk in diabetic patients admitted for CVD, and 2) assessing the feasibility and acceptability of a novel, multifactorial intervention designed to reduce 30d readmissions. The intervention adapts methods successfully used in other inpatient populations to diabetic patients hospitalized for CVD and will target those identified as high risk for readmission based on the DERRI-CVD. There are 2 Phases to the proposed research that address these aims: Phase 1 uses a new retrospective cohort of diabetic patients to validate and refine the DERRI-CVD for prediction of 30d readmission risk; Phase 2 involves a single-arm pilot trial to qualitatively assess the feasibility and acceptability of the intervention. In order to successfully complete the proposed research and build on skills to achieve the overall goal of independence, Dr. Rubin will receive additional training through formal coursework and structured mentorship in the following: validating and refining predictive models, clinical trials, and principles of hospital quality improvement with a focus on readmission prediction and prevention. A distinguished group of senior investigators will serve as mentors and advisors to supervise Dr. Rubin's research and career development. The proposed research and training will help Dr. Rubin acquire skills, establish a body of work in this area and generate preliminary data to support a competitive R01 application to test the readmission risk reduction intervention in a randomized controlled trial. Such work is highly relevant in the current era of soaring health care costs and national health care reform. This proposal will enable Dr. Rubin to develop into a successful independent investigator while improving patient care and reducing readmission disparities through clinical research.
Hospital readmissions within 30 days of discharge are a common and expensive problem. Patients with diabetes and cardiovascular disease, especially racial minorities and urban populations, are at particularly high risk of readmission. The proposed research will verify and improve the accuracy of a new tool to predict 30 day readmission risk and explore the feasibility and acceptability of patient education, adjustment of diabetes medications, and coordination of care by specialized nurses and community health workers during and after hospitalization to reduce 30 day readmissions among patients with diabetes hospitalized for cardiovascular disease.
