The proposed project initiates a program of highly innovative interdisciplinary research that will advance our understanding of how socioeconomic, psychosocial, behavioral, and clinical factors predict hospital readmissions in adults with cardiovascular disease (CVD). Using nationally representative biennial panel data of U.S. older adults (1992-2010) that are linked with Medicare claims data, the specific aims of this research are threefold: First, describe the characteristics of adults hospitalized for one of three major forms of CVD [heart failure (HF), ischemic heart disease (IHD), and stroke] and examine how an array of largely untested patient characteristics are associated with unadjusted 30-day and 180-day all-cause readmission (or death) after discharge. Second, develop a robust risk model to predict readmissions in CVD patients using a series of multivariate hazard models and performance criteria (calibration and discrimination) to assess the non-clinical and clinical risk factors. Third, evaluate models for specific classifications of CVD (i.e., HF, IHD, and stroke) to determine whether separate models are needed to effectively predict adverse outcomes and stratify risks among cardiovascular patients. Sex, race, and geographic differences will be tested in the CVD model(s) to assess its flexibility and effectiveness for potential use in diverse clinical settings. The foundation for this application is an extension of my interests in how socia and behavioral factors impact human health and aging. However, this research marks a shift from my previous work because it demands new training in the study of CVD and the guidance necessary to integrate Medicare claims data with social survey data. Under the direction of a multidisciplinary and complementary team of mentors (Drs. Eric Peterson and Lesley Curtis) and advisors (Drs. Gerardo Heiss, Kenneth Land, and Redford Williams) who are committed to my development and the success of my research, the K01 award will provide me protected time to acquire new competency in the study of cardiovascular disease and to develop as an independent scientist. Duke University provides an ideal environment to accomplish my proposed research and career goals through intensive mentorship, specialized coursework, didactic workshops, and collaborative interactions with multidisciplinary faculty. As part of my immediate career objectives, I will use the award to accelerate my development as an independent researcher and pursue R01 funding as a junior faculty member at Duke University. My long-term goal is to establish a career pioneering the interdisciplinary study of CVD. Understanding the social, psychosocial, and behavioral determinants of adverse outcomes in adults with CVD is a major goal of Healthy People 2020 and the National Heart, Lung, and Blood Institute. I am confident that the proposed research will provide the science necessary to help identify high-risk patients and will provide new knowledge to develop innovative tools to reduce the excess burden of disease in vulnerable segments of the population.
Cardiovascular disease (CVD) is a major public health burden in the United States. Understanding the socioeconomic, psychosocial, behavioral, and clinical factors associated with adverse outcomes after hospital discharge is a critical step toward reducing the human and financial costs of potentially preventable readmissions and death in adults with CVD.
