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Aim 1 – to recruit and follow for two years a multi-racial cohort of 2,500 adults residing in urban, suburban, and rural areas of Massachusetts and Georgia hospitalized at 6 community teaching and non-teaching hospitals.
Recruit and enroll patients, conduct baseline in-person interview, and review inpatient medical records of this index ACS hospitalization.
Follow patients for two years, reviewing rehospitalization records and electronically-available outpatient records.
Conduct follow-up interviews at 1, 3, 6, and 12 months after discharge from the index hospitalization.
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Aim 2 – Transitions Project
Engage a technical advisory panel in consensus building to assist in the selection and evaluation of measures of transition quality focused on the first 90 days after discharge, extending beyond existing systems limited to the discharge process.
Characterize the transition from hospital to community for ACS patients
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Examine the determinants and outcomes for transition care quality, testing the following hypotheses
H1: Better transition quality is associated with improved post-discharge quality of life.
H2: Better transition quality is associated with longer time to first ED visit or rehospitalization.
H3: Patients who are potentially vulnerable due to (a) race/ethnicity, (b) socioeconomic status, (c) total morbidity burden, or (d) cognitive status will have worse transition quality.
H4: Transition quality partially mediates observed disparities in outcomes for vulnerable patients.
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Aim 3 – Action Scores Project
Develop and validate two kinds of “CVD Action Scores” to predict 1) recurrent cardiac events or death and 2) quality of life.
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Describe longitudinal variation in the Action Scores over 2 years and test the hypothesis:
H5: Observed health disparities for populations vulnerable because of (a) race/ethnicity, (b) socioeconomic status, (c) total morbidity burden, or (d) cognitive status would be reduced if actions identified in the Action Scores were taken by patients and providers.
Develop a dashboard for CVD action based on regression models underlying the Action Scores.
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Aim 4 – Develop a nucleus of early stage investigators (ESIs)
Implement structured mentoring for the ESIs
Engage the ESIs as co-PIs in the two research projects (Aims 2 and 3), and encourage them to take leadership roles in the design and implementation of the cohort (Aim 1)
Assist the ESIs in preparing K- and R-type grant applications
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