Midcareer Mentoring Award for Patient-Oriented Research in Aging

几十年的证据发现，尽管美国的医疗保健成本非常高，但美国老年人 例行公事地接受不理想的护理。虽然已经做出了巨大的努力来改革医疗保健 通过政策交付和支付改革来优化成本-质量权衡，人们对此知之甚少 这些变化是否实现了改善美国老年人护理的目标，如果没有，如何 改进它们，让它们做到这一点。我目前的研究创新性地利用国家数据集进行 严格评估这些政策对向老年人提供护理的影响。除了它的 在方法上的严谨性，我的研究采取了现实世界的方法，评估对双方都重要的结果 患者和提供者。到目前为止，我进行了一项高影响力的研究，考察了医疗保健的效果 关于老年人的政策，特别侧重于改进质量衡量，评价政策是否 旨在提高质量和价值的激励措施是有效的，并评估这些方面的哪些方面 措施和激励措施起作用还是不起作用。这项研究提供了实践经验教训，如何 改进质量改进举措，并帮助规划和实施新的 创新的交付系统，旨在改善患者护理。它也对临床产生了重大影响 老年人的实践和政策。我将继续进行这项研究。展望未来，我的目标是扩大 我的研究项目旨在检查医疗保健政策和支付改革对患有 痴呆症，这是一个特别脆弱的群体，可能会经历许多意想不到的后果 从支付改革中获益；并利用我的研究计划培训和指导该领域的新调查人员 改善老年人的医疗保健服务。因此，这项建议的具体目的是：(1)进行 检验卫生保健政策和提供系统对保健质量的影响的高质量研究 患有慢性复杂疾病的老年人，目标是将这项研究扩大到检查这些 对阿尔茨海默病和相关痴呆症患者的影响；以及(2)以我的研究为平台 指导新的研究人员改善老年人的医疗保健服务，帮助他们独立 并支持扩大这一领域，配备训练有素、以病人为导向的老龄研究人员。我的 总体目标是提高患有慢性病和复杂疾病的老年人的护理质量。 最终，我正在进行的和拟议的研究，加上我的导师计划，培养了优秀的 现场调查人员将帮助解决改革医疗保健提供系统的迫切需要，以 有效地提高数百万需要更好护理的老年美国人的质量。

Decades of evidence has found that despite the very high cost of health care in the US, older Americans routinely receive care that is suboptimal. While there have been enormous efforts to reform health care delivery through policy and payment reform to optimize the cost-quality tradeoff, relatively little is known about whether these changes have achieved the goal of improving care for older Americans and, if not, how to improve them so that they do. My current research makes innovative use of national datasets to conduct rigorous evaluations of the impact of these policies on the care provided to older adults. In addition to its methodological rigor, my research takes a real-world approach, evaluating outcomes that matter to both patients and providers. To date, I have conducted high-impact research examining the effect of health care policies on older adults, focusing in particular on improving quality measurement, evaluating whether policies and incentives aimed at improving quality and value are effective, and assessing which aspects of these measures and incentives work versus don't work. This research has provided practical lessons on ways to improve quality improvement initiatives and has helped inform the planning and implementation of new innovative delivery systems designed to improve patient care. It has also had a significant impact on clinical practice and policy for older adults. I am to continue conducting this research. Looking forward, I aim to expand my research program to examine the impact of health care policies and payment reform on older adults with dementia, a group that is particularly vulnerable and may experience numerous unintended consequences from payment reform; and to use my research program to train and mentor new investigators in the field of improving health care delivery for older adults. Thus, the specific aims of this proposal are: (1) To conduct high-quality research examining the impact of health care policies and delivery systems on quality of care for older adults with chronic and complex illness, with the goal of expanding this research to examining these effects in person with Alzheimer's disease and related dementias; and (2) To use my research as a platform to mentor new investigators in improving health care delivery for older adults, to help them become independent investigators and support the expansion of the field with well-trained patient-oriented researchers in aging. My overall objective is to improve the quality of care for older adults with chronic and complex diseases. Ultimately, my ongoing and proposed research, coupled with my mentorship program to train outstanding investigators in the field, will help address the critical need to reform the health care delivery system to efficiently improve quality for the millions of aging Americans who are in need of better care.