Testing the Effectiveness of Individualized Disease Prevention for Middle-Aged Adults

项目总结/摘要 该提案旨在帮助中年人（50-64岁）就健康做出明智的决定 最有可能促进更长寿、更健康生活的护理服务。目前有26个基于证据的 在中年人中，预防或管理慢性病的服务，但很难全部遵循。患者需要 有助于更好地理解服务之间的权衡。 为了克服这些障碍，我们目前正在进行R21，确定预防服务与 对预期寿命的影响最大，并使患者和提供者参与共同决策。患者 供应商高度重视该框架。我们还在开发概念验证，以访问和打印 电子健康记录的结果。 此外，我们将考虑我们的框架对COVID-19对预防保健影响的评估 一般人群的需求。 该提案有五个目标。首先，我们将采用以前发表的分析模型来衡量 质量调整的预期寿命与坚持26项主要预防保健服务中的24项有关。结果 将根据患者的年龄和风险因素进行个体化。其次，我们将整合以前开发的 电子健康记录的决策辅助。我们将进行迭代测试，以确保准确性， 有用性第三，我们将进行一项随机试验，以测试决策辅助工具对中- 不同初级保健诊所的老年患者行为。在临床访问期间，患者和医生将讨论 决策援助和参与共同决策，优先考虑预防保健目标。我们将测量 干预组和对照组患者预防保健利用的变化。第四，利用大 电子健康记录数据库，我们将评估COVID-19对患者层面疾病风险的影响 这些因素以及由此产生的疾病预防需求。第五，我们将制定具有国家代表性的优先事项， 改善疾病预防，包括COVID-19前后的社交距离。 这项建议建立在我们的跨学科团队在临床研究，数学， 建模、共享决策和信息技术。成功的干预措施应有助于 从根本上改变美国的预防保健服务，以最大限度地提高健康和预防疾病， 中年人口。

Project Summary/Abstract This proposal seeks to help middle-aged adults (aged 50-64 y) make an informed decision about the health care services that are most likely to promote a longer, healthier life. There are currently 26 evidence-based services to prevent or manage chronic disease in middle-age, but it is difficult to follow them all. Patients need help to better understand the tradeoffs between services. To overcome these barriers, we are currently conducting an R21 that identifies the preventive services with the greatest impact on life expectancy, and engages patients and providers in shared decision-making. Patients and providers highly value the framework. We also are developing proof-of-concept to access and print the results in the electronic health record. Additionally, we will consider our framework’s assessment of the impact of COVID-19 on preventive care needs in the general population. This proposal has 5 aims. First, we will adapt a previously-published analytic model to measure the gain in quality-adjusted life expectancy associated with adherence to 24 of 26 major preventive care services. Results will be individualized for a patient’s age and risk factors. Second, we will integrate a previously-developed decision aid with the electronic health record. We will conduct iterative testing to ensure accuracy and usefulness. Third, we will conduct a randomized trial to test the effectiveness of the decision aid on middle- aged patient behavior in diverse primary care clinics. During clinical visits, patients and physicians will discuss the decision aid and engage in shared decision making, to prioritize preventive care goals. We will measure the change in preventive care utilization between intervention and control patients. Fourth, utilizing a large database of electronic health records, we will assess the impact of COVID-19 on patient-level disease risk factors and resulting need for disease prevention. Fifth, we will develop nationally-representative priorities to improve disease prevention, both pre- and post-COVID-19 social distancing. This proposal builds upon our inter-disciplinary team’s strong foundation in clinical research, mathematical modeling, shared decision-making and information technology. A successful intervention should help to fundamentally change preventive care delivery in the United States, to maximize health and prevent illness in the middle-aged population.