With the aging of the U.S. population, enormous efforts have been devoted to reforming health care delivery to optimize the cost-quality tradeoff for older adults, including publishing quality information on health care providers altering payment systems to reward the quality and value of care and transforming primary care delivery to focus on patient-centered, high-value care. Yet relatively little is known about whether these changes achieve their goal of improving care for older Americans and, if not, how to improve them so they do. My current research makes innovative use of national datasets to conduct rigorous evaluations of the impact of these policies on the care for older adults. These studies have evaluated whether or not quality measures and incentives aimed at improving quality of care for older patients work, what aspects of these measures and incentives works versus doesn't work, and how to improve quality measurement and incentives. This research has provided practical lessons on ways to improve quality improvement initiatives, has informed the planning and implementation of new innovative delivery systems, and has had a significant impact on clinical practice and policy for older adults.
I aim to continue conducting this research Looking forward, I also aim to expand my research program from examining the impact of health care policies on older adults to implementing and evaluating health care delivery innovations designed to improve the health and wellbeing of older adults~ and to use my research program to train and mentor new investigators in the field of improving health care delivery for older adults. Thus, the SPECIFIC AIMS of this proposal are: 1) To conduct high-quality research examining the impact of health care policies and delivery systems on quality of care for older adults with chronic and complex illness, with the goal of improving the quality with a new direction on the design and testing of innovative health care delivery interventions to improve patient care.
This aim will be accomplished through the completion of currently funded observational studies focusing on improving the use of quality measures and incentives in nursing homes and the conduct of new intervention-based studies of delivery transformation. And 2) To use my research as a platform to mentor new investigators in improving health care delivery for older adults, to help them become independent investigators and support the expansion of the field with well-trained patient-oriented researchers in aging.
This aim will be accomplished through direct involvement of my trainees in my ongoing and new observational studies and clinical trials~ leveraging my programmatic research infrastructure to enable my mentees'investigations~ and ongoing recruitment of high-caliber mentees to my research and mentoring program. My overall goal is to improve the quality of care for older adults with chronic and complex diseases. Ultimately, my ongoing and proposed research, coupled with my mentorship program to train outstanding investigators in the field, is designed help address the critical need to reform the health care delivery system to efficiently bring high quality care to te millions of aging Americans in need of better care.
With this K24 award, Dr. Rachel Werner will continue to develop her successful research program aimed at improving the delivery of care for older patients with complex and chronic illness, with a new focus on the implementation and evaluation of delivery system innovations using randomized trials. She will use her research as a platform to mentor new investigators in this field and help them to become independent investigators. Taken together, her ongoing and proposed research, coupled with her mentorship program to train outstanding investigators in the field, will help address the critical need to reform the health care delivery system to efficiently bring high quality care to the millions of aging Americans in need of better care.
|Ryskina, Kira L; Konetzka, R Tamara; Werner, Rachel M (2018) Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations. Inquiry 55:46958018787323|
|Aysola, Jaya; Schapira, Marilyn M; Huo, Hairong et al. (2018) Organizational Processes and Patient Experiences in the Patient-centered Medical Home. Med Care 56:497-504|
|Konetzka, R Tamara; Skira, Meghan M; Werner, Rachel M (2018) Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs. Am J Health Econ 4:105-130|
|Navathe, Amol S; Bain, Alexander M; Werner, Rachel M (2018) Do Changes in Post-acute Care Use at Hospitals Participating in an Accountable Care Organization Spillover to All Medicare Beneficiaries? J Gen Intern Med 33:831-838|
|Konetzka, R Tamara; Stuart, Elizabeth A; Werner, Rachel M (2018) The effect of integration of hospitals and post-acute care providers on Medicare payment and patient outcomes. J Health Econ 61:244-258|
|Werner, Rachel M; Konetzka, R Tamara (2018) Trends in Post-Acute Care Use Among Medicare Beneficiaries: 2000 to 2015. JAMA 319:1616-1617|
|Ryskina, Kira L; Polsky, Daniel; Werner, Rachel M (2017) Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015. JAMA 318:2040-2042|
|Faherty, Laura J; Wong, Charlene A; Feingold, Jordyn et al. (2017) Pediatric Price Transparency: Still Opaque With Opportunities for Improvement. Hosp Pediatr 7:565-571|
|Neuman, Mark D; Silber, Jeffrey H; Passarella, Molly R et al. (2017) Comparing the Contributions of Acute and Postacute Care Facility Characteristics to Outcomes After Hospitalization for Hip Fracture. Med Care 55:411-420|
|Neuman, Mark D; Werner, Rachel M (2016) Marital Status and Postoperative Functional Recovery. JAMA Surg 151:194-6|
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