Evaluation of Multi-level factors Associated with post-ERCP Outcomes - Project Summary/Abstract This K23 proposal will complete Anna Tavakkoli, MD, MSc’s training towards her long-term career goal of becoming an independent clinician investigator and leader in advanced endoscopy. Dr. Tavakkoli is an advanced endoscopist in the Division of Digestive and Liver Diseases at the University of Texas Southwestern (UTSW) with Master’s training in health services research principles. This proposal builds on Dr. Tavakkoli’s prior experience, leveraging advanced statistical methods, utilizing complex datasets, developing a prospective patient cohort, and the rich training environment at UTSW to improve our understanding of ERCP outcomes and costs throughout the United States. The research will be completed under the guidance of her primary mentor, Amit G. Singal MD, MSc, and co-mentor, B. Joseph Elmunzer MD, MSc, with a planned mentor-the-mentor strategy and additional input from an advisory board of physician-investigators. The 5-year plan includes formal coursework, professional development, and mentored research, with defined milestones to ensure productivity and a successful transition to independence. This mentored research has 3 Specific Aims: • AIM 1 Characterize variation in, and identify patient-, provider, and system-level covariates for post-ERCP outcomes. • AIM 2a Characterize 30-day post-ERCP variations in healthcare utilization, Medicare expenditures and drivers of expenditures across US health systems. • AIM 2b Enumerate out-of-pocket and indirect costs associated with post-ERCP adverse events. • AIM 3 Model the impact of potential intervention strategies to improve post-ERCP pancreatitis. Inherent to completing these high-level aims, Dr. Tavakkoli will also (1) characterize variation in post-ERCP outcomes across Medicare beneficiaries; (2) identify key patient-, provider-, and system-level correlates associated with variation in post-ERCP outcomes; (3) characterize Medicare expenditures as it relates to ERCP; (4) characterize healthcare utilization, and correlates that contribute to variations in utilization, as it relates to post-ERCP outcomes; (5) characterize indirect costs associated with post-ERCP adverse events through direct patient contact; (6) utilizing decision analytic modeling to understand the clinical impact that various intervention strategies, such as a selective referral approach to high-volume endoscopists, could have on rates of post-ERCP pancreatitis. This work will build to an R01 proposal focused on: 1) Building a multi-center prospective cohort to identify granular clinical factors associated with post-ERCP adverse events; 2) Evaluating patient and provider acceptance of intervention strategies; 3) Cost-effectiveness of intervention strategies from our decision analytic model. Beyond establishing a foundation for a programmatic line of research to improve endoscopic care for patients, this proposal will support and accelerate the career development activities of Dr. Tavakkoli, allowing her to successfully launch into the next phase of her career as an independent investigator.
