Project Description
Potentially Burdensome Utilization After Functional Disability
Older
adults with functional disability are at heightened risk for symptom burden and
death. They also often experience expensive and potentially burdensome
healthcare utilization. However, outcomes after functional disability are
heterogeneous and utilization patterns over time have not been clearly
demonstrated. Understanding utilization patterns after functional disability is
an important step to develop approaches to target interventions towards the
highest risk population of older adults. My goal is to become an independent
clinician-investigator assessing and informing models of care for older adults
with functional decline and serious illness. In this proposal I outline a
research project, mentorship strategy, and development plan to catalyze my
development as an independent investigator. I plan to use novel longitudinal
analysis methods to examine the experiences of the highest risk population of
older adults with functional disability within the Medicare-linked National
Health and Aging Trends Study. This will involve: (1) measuring the role of
disability in predicting patient-centered, claims-based measures such as
Emergency Department visits, transitions in care, and days at home; (2)
defining the trajectories of total healthcare expenditures after incident
disability using cutting-edge growth based trajectory analysis methods; and (3)
assessing the clinical, demographic, socioeconomic and household factors
shaping future trajectories of utilization for this population. These research
aims are tightly linked with development aims to build my skills in (1) claims
analysis, (2) longitudinal and group based trajectory analysis, and (3) serious
illness payment policy. This work will form the basis for a K-award to further
assess the patient and caregiver experience and to identifiable potentially
modifiable health system factors that shape trajectories after functional
disability. Ultimately, this work will inform the use of functional disability
markers within care models and payment policies to improve the care of
high-risk older adults.
Bio
Claire K. Ankuda, MD, MPH, is an Assistant Professor in the
Department of Geriatrics and Palliative Medicine at the Icahn School of
Medicine at Mount Sinai. A Vermonter, she earned an MD from the
University of Vermont and a MPH from the Harvard School of Public Health before
going to the University of Washington for family medicine residency. She
was then a Robert Wood Johnson Clinical Scholar at the University of Michigan
during which time she conducted a 6-month policy externship at the Center for
Medicare & Medicaid Innovation. Following this, she completed a
Palliative Medicine fellowship at Mount Sinai. Dr. Ankuda is a health
services researcher who aims to assess the impact of payment policies and
health systems on outcomes for seriously ill older adults and their families.
Email: claire.ankuda@mssm.edu