Vulnerability and Continuity of Care

Continuity of care with an individual physician may be more important for vulnerable older adults. This K08 career development award will: 1) determine if continuity of care with an individual physician has an effect over and above continuity with a site on health care, health outcomes and costs for older adults, 2) characterize vulnerability using a resource-based framework and then determine if this approach improves our understanding of how continuity with a physician and site affects older adults' health outcomes, and 3) determine the effect of distinct aspects of continuity of care with a physician (e.g. trust) and site on older adults' health care and health outcomes.

Hospital Discharge Summary Impact on Patient Health Outcomes

Despite the critical importance discharge summaries play in care transitions and patient safety, no studies have examined how discharge summaries affect patient outcomes.  In this project, we examine whether omission of recommended discharge summary components increases risk of poor health outcomes in hip fracture, cancer and stroke Medicare beneficiaries discharged from a large academic hospital to sub-acute care settings (i.e. skilled nursing facilities, long-term care centers or rehabilitation facilities) during the years 2003, 2004 and 2005.  Patient health outcomes, including cost, survival and number of 30 day bounce-backs, are to be obtained via linkage of hospital discharge summary data to Medicare data.

Guideline Adherence and Health Outcomes in Patients with Diabetes

There is increasing recognition that treatment recommendations considered appropriate for younger individuals with diabetes may confer greater short-term risks and fewer long-term benefits for older patients and those with co-morbid conditions, yet little empirical evidence exists to guide providers in tailoring treatment for these patients.  In this project, we aim to define the outcomes of tight disease control for older adults and those with co-morbid congestive heart failure and chronic kidney disease.  Measures of disease control (hemoglobin A1c, LDL cholesterol, and blood pressure values) will be obtained from electronic health records for patients receiving diabetes care at the UW Medical Foundation and linked to claims data from Medicare and several private insurers to determine if tight disease control is related to increased risk of emergency room visits, hospitalization and/or death for patients with these comorbidities.  The results of this investigation will help provide an evidence base for tailoring diabetes treatment guidelines, developing quality metrics that may be used in pay-for-performance initiatives and other quality improvement efforts, and ultimately improving medical care for older patients with diabetes and/or those with other chronic health conditions.