Implementing patient-centered strategies to optimize hospitalization decisions for emergency department patients with acute heart failure

Abstract/Project Summary Candidate: Austin Kilaru, MD MSHP, is an emergency physician and health services researcher who is committed to improving outcomes for patients with acute cardiovascular illness through the implementation of evidence-based care. To achieve his career goal of becoming an independent investigator, he seeks mentored research training to strengthen skills in qualitative methods, causal inference, and implementation science. Research Context: Each year, there are 1.4 million visits to US emergency departments (EDs) for acute heart failure (AHF). Stable patients can be discharged from the ED after initial evaluation and treatment, but nearly 90% of patients are hospitalized. Evidence-based risk scores have been developed to inform hospitalization decisions for AHF, given that patients may prefer to recover at home and the costs and outcomes associated with hospitalization. However, AHF risk scores are not widely used. Moreover, they do not consider additional factors that may be important to hospitalization decisions, including access to care, capacity for self-care, and health-related social needs. Scalable approaches, like clinical decision support tools, are needed to promote AHF risk stratification and supplement risk scores with additional factors that matter to patients and clinicians. Specific Aims: 1) Identify factors that influence AHF hospitalization decisions for ED patients and physicians; 2) Compare outcomes for low-risk AHF patients who are hospitalized to those discharged from the ED; 3) Pilot and evaluate implementation of a clinical decision support tool for AHF hospitalization. Research Plan: To accomplish these aims, Dr. Kilaru will first conduct qualitative interviews with low-risk AHF patients who were either hospitalized or discharged from Penn Medicine EDs. He will also conduct interviews with ED physicians to examine decision-making factors. Then, he will use electronic health record data for a retrospective cohort study to determine the association of hospitalization with outcomes among low-risk AHF patients, seeking to further test AHF risk score effectiveness and inform implementation strategies. Finally, he will design and implement a clinical decision support tool, based in the electronic health record (EHR), among ED physicians at Penn Medicine, evaluating outcomes including acceptability, adoption, and feasibility. Career Development Plan: Working closely with his mentorship team, Dr. Kilaru will pursue didactics, seminars, and individualized instruction to complete his training goals, which are to 1) expand skills in qualitative methods to focus on patients and clinicians 2) apply causal inference techniques to analyze EHR data, and 3) gain implementation science expertise to design and test innovations in care delivery. Environment: The University of Pennsylvania and Penn Medicine offer an ideal environment to pursue this training and research. Dr. Kilaru will succeed because of the support of an experienced and dedicated mentorship team, outstanding research infrastructure, and extensive resources for professional development.