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Understanding and Predicting High-Need, High-Cost Patients among Older Adults

Award Number: R00AG064030
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/01/2019
PERIOD OF PERFORMANCE END DATE: 04/30/2024

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Understanding and Predicting High-Need, High-Cost Patients among Older Adults - PROJECT SUMMARY/ABSTRACT This is a K99/R00 Pathway to Independence Award submitted to the National Institute on Aging by Yongkang Zhang, a Research Associate in the Department of Healthcare Policy and Research at Weill Cornell Medical College (WCMC). Dr. Zhang’s career goal is to become an independent researcher on improving care for the elderly through developing and applying effective prediction tools to identify older adults with complex conditions and high healthcare needs. This K99/R00 application will provide Dr. Zhang with the necessary training 1) to understand the complexity and characteristics of high-need, high-cost (HNHC) older adults; 2) to develop a prediction model for HNHC adults using machine learning methods; and 3) to test the performance of the machine learning-based model with three commonly used, patient-risk prediction tools. Dr. Zhang has assembled a mentor team of accomplished researchers across multiple divisions and departments at Weill Cornell Medical College: Dr. Rainu Kaushal (primary mentor) who is the Nanette Laitman Distinguished Professor and an expert on the HNHC patients and health data science; Dr. Lawrence Casalino (co-mentor) who is the Livingston Farrand Professor of Public Health and an expert on characteristics of and healthcare delivery for HNHC patients; Dr. Mark Lachs (co-mentor) who is a Professor of Geriatrics and prac- ticing geriatrician and an expert on the complexity and healthcare needs of older adults; Dr. Yuhua Bao (co- mentor) who is an Associate Professor of Healthcare Policy and Research and expert on behavioral health conditions and prescription data; Dr. Fei Wang (co-mentor) who is an Associate Professor of Health Informat- ics and an expert on machine learning methods; and Dr. James Flory (consultant) who is an Assistant Profes- sor of Healthcare Policy and Research and practicing clinician and an expert on medication use. HNHC older adults are small group of patients representing a disproportionate share of healthcare utili- zation. These patients are more likely to experience preventable quality and safety problems due to their fre- quent interactions with health systems. Caring for HNHC older adults provides great potential benefits for qual- ity improvement and cost reduction. However, the benefits are unlikely to be realized unless these patients can be correctly identified and targeted. Building on his previous research and training on developing a claims data-based taxonomy for HNHC Medicare patients, Dr. Zhang’s research will understand the characteristics of HNHC older adults and develop predictors for these patients using clinical and prescription data (Aim 1), de- velop a machine learning-based prediction model for HNHC older adults (Aim 2), and compare the perfor- mance of the prediction model with three commonly used, patient risk prediction tools (Aim 3). This research will be the foundation for an R01 grant application that will incorporate this prediction model into healthcare de- livery process and identify the optimal ways to inform opportunities for improvement in healthcare delivery.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$15 )
2025	2023	WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY	575 LEXINGTON AVE FL 9	NEW YORK	NY	10022	NEW YORK	USA	Aging Research	000	4	10/9/2024	NON-COMPETING CONTINUATION	-$15
														Subtotal = -$15

Issue Date FY: 2023 ( Subtotal = $249,000 )
2023	2023	WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY	1300 YORK AVE	NEW YORK	NY	10065	NEW YORK	USA	Aging Research	000	4	5/22/2023	NON-COMPETING CONTINUATION	$249,000
														Subtotal = $249,000

Issue Date FY: 2022 ( Subtotal = $267,079 )
2022	2022	WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY	1300 YORK AVE	NEW YORK	NY	10065	NEW YORK	USA	Aging Research	002	3	9/7/2022	EXTENSION WITH OR WITHOUT FUNDS	$18,079
2022	2022	WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY	1300 YORK AVE	NEW YORK	NY	10065	NEW YORK	USA	Aging Research	001	3	6/14/2022	EXTENSION WITH OR WITHOUT FUNDS	$0
2022	2022	WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY	1300 YORK AVE	NEW YORK	NY	10065	NEW YORK	USA	Aging Research	000	3	5/13/2022	EXTENSION WITH OR WITHOUT FUNDS	$249,000
														Subtotal = $267,079

Grand Total All Awards = $516,064

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Understanding and Predicting High-Need, High-Cost Patients among Older Adults

Award Number: R00AG064030

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 07/01/2019

PERIOD OF PERFORMANCE END DATE: 04/30/2024

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