Midcareer Mentoring Award for Patient-Oriented Research in Aging

数十年的证据表明，尽管美国的医疗保健成本非常高，但美国老年人 经常接受次优护理。尽管在改革医疗保健方面做出了巨大的努力， 通过政策和支付改革来优化成本-质量权衡， 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 改善他们，使他们这样做。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。除了其 我的研究方法严谨，采用现实世界的方法，评估对双方都重要的结果， 患者和供应商。到目前为止，我已经进行了高影响力的研究，检查医疗保健的影响， 老年人政策，特别侧重于改进质量衡量，评估政策是否 旨在提高质量和价值的激励措施是有效的，并评估这些措施的哪些方面 措施和激励措施是否有效。这项研究提供了关于如何 改进质量改进举措，并帮助规划和实施新的 旨在改善患者护理的创新输送系统。它也对临床产生了重大影响。 为老年人制定的政策和措施。我将继续进行这项研究。展望未来，我的目标是 我的研究项目是研究医疗保健政策和支付改革对老年人的影响， 痴呆症，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;并利用我的研究计划，以培训和指导新的调查人员在该领域的 改善老年人的医疗保健服务。因此，本建议的具体目标是：（1）开展 高质量的研究，审查卫生保健政策和提供系统对护理质量的影响， 患有慢性和复杂疾病的老年人，目的是扩大这项研究，以检查这些 对阿尔茨海默病和相关痴呆症患者的影响;（2）利用我的研究作为平台， 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 研究人员，并支持该领域的扩展与训练有素的面向病人的研究人员在老龄化。我 总体目标是提高对患有慢性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，以培养优秀的 实地调查人员将帮助解决改革卫生保健提供系统的迫切需要， 有效地提高数百万需要更好护理的美国老年人的质量。

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.