Summaries of Independent Scientist (K) Awards

Auerbach, Andrew D.

Institution: University of California, San Francisco (UCSF)
Grant Title: Medical-Surgical Co-management Evaluating a New Award
Grant Number:  K08 HS11416
Duration: 5 years (2002-2007)
Total Award: $608,850

Project Description: This project has been completed.  It had three main goals:

1. Derivation of a medical complication risk index to identify high risk patients.
2. A randomized control trial of co-management of at-risk patients identified by the index, and will examine co-management's impact on patient safety (as measured by medical complication rates), utilization, and patient satisfaction.
3. Refinement of data collection strategies for use in future multi-center studies.

Career Goals: Dr. Auerbach is Assistant Professor in Residence in the Department of Medicine at UCSF.  He completed a fellowship in General Internal Medicine and received an M.P.H. from Harvard School of Public Health in 1998.  He is also on the faculty at UCSF as a clinician-researcher and hospitalist in the Department of Medicine.  His clinical responsibilities involve patient care on the general medical ward and medical consultation service. This award will allow the candidate to develop new skills important to his clinical and research career.  It will also provide a setting in which he will become an independent investigator in perioperative medicine outcomes research and organizational methods to improve perioperative patient safety. 

Progress to Date: Using prospectively collected data, Dr. Auerbach's research team planned to compare rates of use of proven medical therapies (i.e., appropriate prophylaxis for deep venous thrombosis) and incidence of medical complications (i.e., postoperative pneumonia, surgical site infections) thought to be measures of patient safety, as well as length of stay and costs of care. Housestaff duty-hour reductions in 2003 forced an indefinite delay in the implementation of a hospitalist-staffed surgical comanagement service at Moffitt-Long Hospital so the research program was retooled to examine impact of usual consultative practices on care quality, using a combination of chart abstraction and administrative data.  It was found that early consultation by any internist had little impact on care quality or care efficiency.  However, if consultation was by a generalist, patients tended to have more frequent appropriate use of beta-blocker, deep vein thrombosis prevention measures, and shorter length of stay.  These finds supported two successful National Institutes of Health (NIH) grants to support research extending these findings.

Highlights and Accomplishments:

• Clinician on the general medicine ward service.
• Co-chair on the UCSF perioperative patient safety committee focusing on appropriate use of perioperative beta-blockers.
• Chair of the California State Centers for Medicare & Medicaid Services (CMS) initiative to reduce surgical site infections.
• Mentor of junior faculty and fellows.
• Deputy Editor for the Journal of General Internal Medicine

K-Generated Publications (selected):

Fang M, Minichiello TM, Auerbach AD. Cost considerations surrounding current and future anticoagulant therapies.  Cleveland Clinical Journal of Medicine 2005. Apr; 72(Suppl 1):S43-9.

Auerbach AD. Long live generalism: Hospital medicine and the Journal of General Internal Medicine. Journal of General Internal Medicine 2005. Feb; 29(2):208-9.

Vidyarthi A, Auerbach AD. Is 80 the cost of saving lives? Reduced duty hours, errors, and cost. Journal of General Internal Medicine 2005. 20(10):969-70.

DiFrancesco L, Pistoria MJ, Aubach AD, Nardino RJ, Holmboe ES. Internal medicine training in the inpatient setting. A review of published educational interventions. Journal of General Internal Medicine 2005. 29(12):1173-80.

Vidyarthi A, Katz PK, Wachter RM, Auerbach AD. Impact of reduced duty hours on residents' educational satisfaction at the University of California, San Francisco. Academy Medicine 2006. 81(1):76-81.

Pantilat SZ, Rabor M, Citco J, VonGunten CF, Auerbach AD, Ferris FD. Evaluating the California hospital initiative in palliative services. Archives of Internal Medicine 2006.  166(2):227-30.

Auerbach AD, Goldman L. Contemporary reviews in cardiovascular medicine: Assessing and reducing the cardiac risk of noncardiac surgery. Circulation 2006.113(1):1361-76.

Auerbach AD, Chlouber R, Singler J, Wachter RM. Trends in Internal Medicine employment advertisements, 1996-2004. Journal of General Internal Medicine 2006 (21);1079-85.

Ong M, Bostrom A, Vidyarthi A, Auerbach AD, et al. House staff team workload and organization effects on patient outcomes in an academic general internal medicine inpatient service. Archives of Internal Medicine 2007. 167:47-52.

Auerbach AD, Rasic MA, Sehgal N, et al. Opportunity missed: Medical consultation, resource use, and quality of care of patients undergoing major surgery. Archives of Internal Medicine 2007. 167(21):2338-44.

Auerbach AD, Landefeld CS, Shogania KS. The tension between need to improve care and knowing how to do it.  New England Journal of Medicine 2007. 357(6):608-13.

Auerbach AD, Maselli, J., et al. Opportunity missed: Impact of medical consultation on quality of care and outcomes following major surgery. Archives of Internal Medicine 2007. 167(21):2338-44.

Ranji S, Auerbach AD, Shojania KG. Effects of rapid response systems on clinical outcomes: Systematic review and meta-analysis.  Journal of Hospital Medicine 2007. 2(6):422-32.

Return to Recently Funded Career Development Award Grants
Proceed to Next Section