PROJECT SUMMARY/ABSTRACT CANDIDATE: Michael P. Thompson, PhD, is an epidemiologist, health services researcher, and faculty member in the Department of Cardiac Surgery at the University of Michigan. His long-term career goal is to conduct impactful, significant, and innovative research that improves the value of cardiac surgery. The proposed K01 award application includes a 5-year plan for career development and research activities needed to achieve this career goal and become a successful independent investigator. BACKGROUND: Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention that improves outcomes, but has not been widely adopted. Among cardiac surgical patients, clinical trials have demonstrated that CR extends life, improves cardiovascular function and quality of life, and prevents downstream health care utilization. Despite this evidence, half of cardiac surgical patients never attend a single session of CR, and only one-third of CR enrollees finish the entire 36 recommended sessions. Disparities in CR enrollment across have also been demonstrated across patients, providers, and geographic regions. Improving CR enrollment is critical to ensuring its full potential for cardiac surgical patients. RESEARCH AIMS: My long-term goal is to improve the value of cardiac surgical care. The aims of this study are: (1) to identify determinants of CR enrollment after cardiac surgery, (2) to measure the effect of CR enrollment after cardiac surgery on clinical and economic outcomes, and (3) to estimate the impact of financial incentives on CR enrollment after cardiac surgery. In order to achieve these objectives, we propose a series of quantitative analyses on a unique combination of claims data and clinical data from the IMPROVE Network, which shares data and best practices across five multicenter cardiovascular quality collaboratives covering over 90 hospitals in 9 states (~10% of all US cardiac surgical programs). TRAINING AIMS: Three training aims have been proposed to facilitate the proposal. (1) To gain a deeper understanding of cardiac surgical care delivery. (2) To gain causal inference skills with in-depth comparative effectiveness and policy evaluation components. (3) To develop skills and experience in implementation science methods. IMPACT: Findings from this proposal will provide evidence needed to develop the necessary evidence to appropriately expand and incentivize CR enrollment after cardiac surgery, which will increase the value of cardiac surgical care. The proposal is directly responsive to AHRQ’s interest in (i) generating evidence that will increase the affordability, efficiency, and quality of health and (ii) health services research to achieve a high- value healthcare system. Above all, the proposed research strategy, career development plan, mentorship, and institutional environment will cultivate my growth into an independent health services researcher.

PROJECT NARRATIVE Cardiac rehabilitation (CR) is purported to improve cardiovascular function, outcomes, and health care utilization after cardiac surgery, but (I) is used variably across patients, providers, and regions, (ii) lacks of substantial and robust evidence for benefit, and (iii) is often the target of financial incentive programs. The proposed research will shed new light on the determinants of CR enrollment after cardiac surgery, the effect of CR enrollment on clinical and economic outcomes, and impact of financial incentives on CR enrollment and subsequent outcomes. The result of this project will provide the evidence needed to develop effective programs and policies designed to improve CR enrollment after cardiac surgery, which will increase the value of cardiac surgical care.