A UCLA-led consortium of five University of California medical schools, plus Cedars-Sinai Medical Center in Los Angeles, has received $9.9 million from the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality to research the use of wireless and telephone care management to reduce hospital readmissions for heart failure patients.
The three-year grant, "Variations in Care: Comparing Heart Failure Care Transition Intervention Effects," is funded under the AHRQ's Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE) program.
"Heart failure patients have high rates of hospital readmissions, and a critical window for preventing readmissions is as the patient transitions from the inpatient to outpatient setting," said Dr. Michael Ong, assistant professor of medicine at the David Geffen School of Medicine at UCLA and the grant's principal investigator. "This project compares two approaches designed to help patients make a smooth transition from inpatient to outpatient care. We will compare whether each approach reduces readmissions among heart failure patients at six different medical centers."
The project will be a three-armed, randomized controlled trial examining the effect of two interventions: managing the transition from inpatient to outpatient care via telephone, and managing the transition from inpatient to outpatient care via wireless remote monitors and telephone. These will be compared to the standard care for heart failure patients.
"This funding is critical if we're to learn how to reinvent health care in the United States," said Dr. Tom Rosenthal, chief medical officer for Ronald Reagan UCLA Medical Center.
"Our goal is to improve quality and reduce cost of care and, most importantly, to identify approaches that are applicable in every community, not only large academic centers."
Given that this research involves not just health care but technology, the project will take a "team science" approach, among the six institutions and within UCLA. The UCLA team comprises members of the Geffen School of Medicine (Dr. Ong; Dr. Carol Mangione; a professor of medicine who holds the Barbara A. Levey MD & Gerald S. Levey MD Endowed Chair in Medicine; Dr. Jos- Escarce, professor of medicine; and Dr. Gregg Fonarow, the Eliot Corday Professor of Cardiovascular Medicine and Science and director of the Ahmanson-UCLA Cardiomyopathy Center); the School of Nursing (Lorraine S. Evangelista, associate professor of nursing); the School of Dentistry (Honghu Liu, professor of dentistry); and the Henry Samueli School of Engineering and Applied Science (Majid Sarrafzadeh, professor of computer science and electrical engineering and co-director of the UCLA Wireless Health Institute).
Ong, Mangione and Escarce are in the UCLA Department of Medicine's Division of General Internal Medicine and Health Services Research. In addition, Mangione and Liu hold joint appointments at the UCLA School of Public Health, and Liu also has a UCLA Department of Medicine appointment. The overall team also includes research teams from UC Davis, UC Irvine, UC San Diego, UC San Francisco and Cedars-Sinai.
"This is a marvelous example of the leadership that UC can offer to all Americans as we collaborate with one another and significant partners like Cedars-Sinai to study interventions that most efficiently help patients navigate transitions from the hospital so that they can avoid preventable readmissions," said Dr. John Stobo, UC senior vice president for health sciences and services. "UC is committed to developing innovations and a new paradigm of health care delivery that creates a culture of deliberate improvement."
This project builds on a study of variations in health care resource use and outcomes among heart failure patients from the five UCs and Cedars-Sinai that was led by Dr. Ong and published last year in the journal Circulation: Cardiovascular Quality and Outcomes. That study found that six-month mortality rates were lower for elderly Medicare heart failure patients hospitalized at centers that used more health care resources, compared with those at hospitals that used fewer resources. These findings suggested that more resource-intensive care may improve outcomes among certain patients with heart failure, the most frequent cause of hospitalization and death among Medicare beneficiaries.
"The new Variations in Care project seeks to improve those outcomes with innovations that require less intensive care resources," Ong said.
The award is part of $473 million in AHRQ grants and contracts that support projects to help people make health care decisions based on the best evidence of effectiveness. The funding, announced Sept. 30, covers all of the AHRQ's allocation and $173 million administered for the HHS Secretary by the AHRQ.
The awards are part of the investments made under the American Recovery and Reinvestment Act of 2009, which included $1.1 billion to support patient-centered outcomes research. These projects will support patient-centered outcomes research, also known as comparative effectiveness research. These efforts encompass many areas, including health care interventions in real-world settings, advanced use of the research findings by diverse populations, development of effective patient registries, and training and career development for the next generation of researchers.
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