PROJECT SUMMARY/ ABSTRACT This K23 award will enable the candidate, Michelle Lin, MD, MPH, MS, to become an independent physician scientist focused on improving patient-reported outcomes for emergency department (ED) care of asthma and other acute cardiopulmonary conditions. Asthma affects 1 in every 12 persons in the U.S., resulting in 1.9 million ED visits annually; however, the impact of ED care on patient-reported outcomes after acute exacerbations is unknown—a gap which limits the evaluation of interventions to improve ED asthma care. In her pilot work, Dr. Lin has identified candidate items and scales for the novel Patient-Reported Outcomes for Acute Asthma Care and Treatment (PROAACT) instrument. During this K23, Dr. Lin will 1) evaluate the validity and reliability of the PROAACT instrument; 2) test whether receiving more guideline- concordant ED care is associated with improved PROAACT responses; and 3) evaluate the association between PROAACT scores and subsequent ED revisits and hospitalizations, which will inform the inclusion of PROAACT and other candidate predictors in future risk adjustment models. To achieve these aims, this proposal includes an integrated curriculum consisting of intensive mentorship and didactic coursework in patient-centered research, instrument development and validation including psychometric methods, clinical data management, and novel approaches to outcome measurement applying geospatial techniques to incorporate social and environmental data known to differentially affect asthma and health outcomes. Dr. Lin’s career development and training activities also include building a research network of peers and collaborators, engaging with asthma patients in local communities, and participating in national scientific meetings. Dr. Lin has assembled a mentorship team of national leaders with expertise in patient-oriented asthma and emergency medicine research, patient-centered outcomes research, instrument development, health care quality measurement, and outcome assessment. The proposed research and didactic plan will allow Dr. Lin to develop expertise in patient-reported outcome performance measure development, become a leader in patient- centered asthma and emergency care research, and enable Dr. Lin's transition to an independent clinical investigator focused on developing, measuring and improving patient- reported outcomes for asthma and other cardiopulmonary conditions. Completion of this project will result in a novel PROM for adult ED asthma patients, advance the understanding of how ED care impacts patient-reported outcomes, and enable interventions to improve outcomes that matter to ED patients with asthma.

PROJECT NARRATIVE Asthma affects 1 in every 12 persons in the U.S., resulting in 1.9 million ED visits annually; however, the impact of ED care on patient-reported outcomes after acute exacerbations is unknown. The proposed research will train a physician-scientist to develop a novel instrument to assess patient-reported outcomes after adult ED asthma visits, test the association between ED clinical quality and patient-reported outcomes, and evaluate the association between patient- reported outcomes and subsequent acute care utilization. The candidate will acquire skills in patient-centered research, instrument development and validation, outcome measurement, and novel approaches to risk adjustment that will enable her transition to independence.