Decades of evidence has found that despite the very high cost of health care in the US, older Americans routinely receive care that is suboptimal. While there have been enormous efforts to reform health care delivery through policy and payment reform to optimize the cost-quality tradeoff, relatively little is known about whether these changes have achieved the goal of improving care for older Americans and, if not, how to improve them so that they do. My current research makes innovative use of national datasets to conduct rigorous evaluations of the impact of these policies on the care provided to older adults. In addition to its methodological rigor, my research takes a real-world approach, evaluating outcomes that matter to both patients and providers. To date, I have conducted high-impact research examining the effect of health care policies on older adults, focusing in particular on improving quality measurement, evaluating whether policies and incentives aimed at improving quality and value are effective, and assessing which aspects of these measures and incentives work versus don't work. This research has provided practical lessons on ways to improve quality improvement initiatives and has helped inform the planning and implementation of new innovative delivery systems designed to improve patient care. It has also had a significant impact on clinical practice and policy for older adults. I am to continue conducting this research. Looking forward, I aim to expand my research program to examine the impact of health care policies and payment reform on older adults with dementia, a group that is particularly vulnerable and may experience numerous unintended consequences from payment reform; 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 expanding this research to examining these effects in person with Alzheimer's disease and related dementias; 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. My overall objective 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, will help address the critical need to reform the health care delivery system to efficiently improve quality for the millions of aging Americans who are in need of better care.

Public Health Relevance

With this K24 award, Dr. Rachel Werner will continue to build her successful research program aimed at improving the delivery of care for older patients with complex and chronic illness and will expand this research to focus on older adults with dementia, a group that is particularly vulnerable and may experience numerous unintended consequences from payment reform. 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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24AG047908-07
Application #
10134168
Study Section
Neuroscience of Aging Review Committee (NIA)
Program Officer
Novak, Priscilla Joy
Project Start
2014-09-15
Project End
2025-02-28
Budget Start
2021-03-01
Budget End
2022-02-28
Support Year
7
Fiscal Year
2021
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
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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