2006 Hartford Outcomes Award Winners
Vineet Arora, MD, MA
University of Chicago
“Measuring the Quality of Care for Hospitalized Vulnerable Elders”
Vineet Arora, MD, MA is an Instructor of Medicine in the Section of General Internal Medicine at the University of Chicago. She completed a fellowship in hospital medicine and a master’s in public policy from the Irving B. Harris School of Public Policy at the University of Chicago. She is the recipient of the Milton W. Hamolsky Award from the Society of General Internal Medicine and a Research Abstract Award from the Association of Program Directors of Internal Medicine. Her current work focuses on assessing quality of care for hospitalized vulnerable elders using measures from the ACOVE (Assessing Care of the Vulnerable Elder) Project, a series of evidence-based quality indicators developed at RAND. She also plans to determine the relationship between these measures to relevant patient outcomes for hospitalized older patients. As the Hospital Care Content Expert for the ACOVE-3 Project, she is completing a systematic review of literature to update the ACOVE hospital care quality indicators.
S. Nicole Hastings, MD
“Incidence and Predictors of Adverse Outcomes in Older Adults Discharged from the Emergency Department”
S. Nicole (Nicki) Hastings, MD, trained in internal medicine at Stanford University Medical Center and is currently completing her geriatrics fellowship at Duke University and the Durham VA Medical Center, supported by a VA Special Fellowship in Advanced Geriatrics. She is also completing coursework toward a Master’s degree in Clinical Research through the Duke Clinical Research Training Program. In July 2006 she will join the Duke geriatrics faculty focusing on health services research. Her current work focuses on the organization and delivery of emergency care to older adults and its impact on health outcomes.
Mentor: Kenneth Schmader, MD
Project Title: Incidence and Predictors of Adverse Outcomes in Older Adults Discharged from the Emergency DepartmentBackground: Transitions of care are a significant problem for older adults in our fragmented health care system.1 Older adults who are evaluated in the Emergency Department (ED) and discharged to home to follow up with their primary care provider (PCP) may be particularly vulnerable to adverse outcomes related to poor care transitions but the extent and nature of this problem has not been adequately investigated.Specific Aims:
1. To determine the incidence and predictors of adverse health outcomes for older adults discharged from the ED using a nationally representative sample of Medicare beneficiaries;
2. To examine the ED discharge process and adverse health outcomes at the patient level using a prospective, cohort study.Design: Two complementary cohort studies
Data for Aim 1 will be derived from the Medicare Current Beneficiary Survey Cost and Use files linked with Medicare claims data. The sample will be limited to community-dwelling MCBS participants aged 65 and over who were discharged from an ED between January and August of 2001. Data for Aim 2 will be collected from patient interviews and medical records of older patients discharged from the Duke ED.Measurements: Independent variables: age, sex, race, health conditions, Charlson Comorbidity Index, self-reported health status, functional limitations, prior health service utilization, marital status, living arrangements, education, income, insurance status, discharge diagnosis and discharge medications. Process measures (Aim 2): binary measures of information provided at discharge and plan for follow-up care. Dependent variables: repeat ED visits, hospitalizations, and death within 90 days of ED discharge.
Analysis: Univariate statistics will be used to describe the patient sample and outcomes. For Aim 2, we will utilize a two-part model to test for associations between our independent variables and outcomes while controlling for other potentially important covariates.
Aanand D. Naik, MD
Baylor College of Medicine
“Goal-Setting for Older Adults with Multiple Morbid Conditions”
Aanand D. Naik, MD, is an assistant professor of health services research and geriatrics at Baylor College of Medicine and the Houston Center for Quality of Care and Utilization Studies at the Michael E. DeBakey VA Medical Center. He came to Baylor in July 2004 after completing his clinical training in Internal Medicine and Geriatrics at UT Southwestern Medical School in Dallas and research training at the Robert Wood Johnson Clinical Scholars Program at Yale University. His research interests include the development of interventions to improve the health outcomes of older adults with multiple morbid conditions. He is specifically interested in using basic and applied research in cognitive psychology to improve the clinical decision making processes and outcomes for older diabetics with multiple morbidities.
Mara Schonberg, MD, MPH
Beth Israel Deaconess Medical Center
“Breast Cancer Screening Characteristics and Outcomes Among Oldest-old Women”
Mara Schonberg, MD, MPH is an Instructor of Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School. Her research is focused on improving decision-making and counseling about disease prevention for older women, especially women aged 80 and older. Her work has examined the prevalence of mammography screening in women aged 80 and older according to life expectancy. She has also explored factors that influence women aged 80 and older’s decision making around mammography screening as well as how women aged 80 and older value disease prevention in general. In addition, she has examined physician counseling about mammography screening and exercise to women aged 80 and older. During her Hartford Geriatrics Health Outcomes Award, Dr. Schonberg will collect data on the benefits and burdens of mammography screening for women aged 80 and older as well as breast cancer characteristics and outcomes for women aged 80 and older.
Name: Mara A. Schonberg, MD, MPH
Mentor: Edward R. Marcantonio, MD, SM and Rebecca Silliman, MD, PhD
Project Title: Breast Cancer Screening Characteristics and Outcomes Among Oldest-Old Women
Although the incidence of breast cancer increases with age and more women are now living well into their 80’s and 90’s, there are few data demonstrating a mortality benefit of breast cancer screening with mammography for women aged 80 or older. In the absence of clinical trial data, physicians must help these women (the oldest-old) make informed decisions about mammography screening. Mammography screening may benefit some women aged 80 or older, while causing burden to other oldest-old women by finding and treating breast cancers that would not have become clinically significant in their life time. More data are needed on the benefits and risks of mammography screening for women aged 80 or older to target mammography screening to oldest-old most likely to benefit and to inform patient decision-making around screening. The first project in this proposal is a retrospective study designed to describe the experiences of oldest-old women who decided to undergo mammography screening and to compare their experiences with those who were not screened. The second project is a secondary analysis of oldest-old women newly diagnosed with breast cancer in the Surveillance, Epidemiology and End Results Program, which will compare breast cancer tumor characteristics at diagnosis, stage-specific treatments and survival of the oldest-old with younger-old women (aged 65 to 79). These data will be used to create tools to help guide patient decision-making and physician counseling about screening mammography. In the future, Dr. Schonberg plans to use the skills she obtains from this award to explore the benefits and risks of other screening tests for elderly women to improve preventive care to oldest-old women.