One quarter of older patients admitted for heart failure are readmitted within 30 days of discharge, resulting inincreased morbidity for seniors and high healthcare costs. In an effort to reduce the readmission rate, a risk-standardized hospital readmission rate for heart failure is now publicly reported, and health reform proposalsinclude penalties for hospitals with high readmission rates. Yet despite this intense public interest, thephenomenon of readmission is poorly understood, and risk-standardized readmission rates vary widely amonghospitals. Since quality of hospital, transitional and post-discharge care plays an important role in readmissionrisk, we approach this problem from a systems perspective. My long-term goal is to develop a research careerdedicated to improving healthcare systems at the local, regional and national level so that they maximize carequality, patient safety, coordination and communication for older patients. The goals of this proposal are tobuild my skillset in this area, acquire data for hypothesis testing and future interventions, and to expand mymentoring relationships to encompass geriatric and transitional care experts. The specific career developmentaims are: (1) to build a foundation of geriatric and aging-related knowledge; (2) to develop expertise in qualityassessment in multiple domains using a variety of techniques; (3) to gain experience in the use and analysis ofMedicare claims data, and in the integration and merging of a diverse group of large datasets; and (4) todevelop advanced expertise in organizational behavior, human ergonomics, systems analysis and othertechniques necessary for building safe and patient-centered healthcare systems. I will accomplish this througha combination of coursework, mentorship and research activities. The research goal of this proposal is todevelop a better understanding of the modifiable healthcare delivery factors that have an impact onreadmissions for geriatric patients. The specific research aims are: (1) to compare clinical, transitional, andpost-discharge care for older patients with heart failure admitted to hospitals in the top, middle and bottom tenpercent of readmission rates nationally; (2) to describe the etiology and preventability of readmissions inpatients admitted to these hospitals; (3) to determine the proportion of variation in risk-standardizedreadmission rates for heart failure attributable to hospital referral region characteristics; and (4) to identifyregional characteristics that are associated with readmission rates for older patients admitted with heart failure.My mentorship team includes experts in heart failure readmissions and quality measurement (H. Krumholz, E.Bradley), and an expert in multifactorial geriatric conditions (M. Tinetti). Relevance: Older patients have adisproportionately high risk of readmission after hospital discharge and are particularly vulnerable toinadequate healthcare systems. This study is intended to identify the areas in which clinicians, hospitals, andthe healthcare environment have influence over readmission rates, in order to develop targeted, high-impactinterventions to reduce morbidity in older patients after the hospital-to-home transition.NO CHANGE
One quarter of patients admitted for heart failure (HF) are readmitted within 30 days ofdischarge. Since older patients are at high risk for adverse events during hospitalizations; andsince rehospitalizations alone cost the healthcare system over $17 billion a year; it is highlydesirable to avoid readmissions by keeping patients healthier. This study is intended todetermine what influence clinicians; hospitals; and the broader healthcare environment haveover readmission rates; in order to develop targeted; high-impact interventions to help keepolder patients with HF safe at home instead of back in the hospital.NO CHANGE
Showing the most recent 10 out of 47 publications
