Long-term effects of today's medical care access policies on the future burden of Alzheimer's disease and related dementias

受快速变化的医疗政策格局的影响，医疗保健的患者成本负担(PCB)是一个 未参保个人和高免赔额健康计划参与者的常见患者报告结果 (人类发展计划，雇主赞助计划的30%)。在这些情况下，多氯联苯对遵守 有助于管理心血管和代谢健康(CMH)的药物。CMH的管理，包括 2型糖尿病(T2 DM)是健康老龄化的重要组成部分，影响阿尔茨海默病的发病风险 和相关痴呆症(ADRD)。为了了解今天的印刷电路板对 健康老龄化和未来的ADRD风险，关键是开发能够模拟 多氯联苯、药物依从性和ADRD之间复杂的相互作用。本申请中建议的工作 根据我调查ADRD保险设计和药物流行病学影响的经验，以及 通过增加对实现我的长期职业目标至关重要的领域的培训来增强它：成为一名 卫生政策与慢性病负担之间关系的主要独立调查者。 该奖项的培训包括开发和应用医疗干预的模拟模型， 政策和利益相关者参与，T2 DM和ADRD，老年研究和护理，以及领导力。最新的 所获得的技能和知识是进行拟议研究所必需的，其目的是检验 印刷电路板在2型糖尿病管理中的作用，并模拟影响印刷电路板的卫生政策如何影响 ADRD的负担。在模拟建模、老年医学、卫生经济学等领域知名领导者的指导下， 卫生政策、ADRD和T2 DM，我将实现以下具体目标：1)模拟 使用真实糖尿病进展模型(Rapids)的T2 DM管理和进展的印刷电路板。 印刷电路板将在非保险和医疗保险计划的背景下进行审查，我们将模拟印刷电路板对 T2 DM管理转化为Rapids的长期CMH结果，这是T2 DM进展的有效模型。 2)构建新的仿真模型，使用近老年人/老年人的生命周期视角连接印刷电路板、T2 DM 进展、ADRD发生率和负担。今天的新医疗保健途径和明天的健康老龄化 (HATHAT)模型将Rapids模型与经过验证的未来老年人模型(FEM)连接起来，以便 全面联系印刷电路板、2型糖尿病治疗、微血管和宏观血管事件以及生物标记物与未来 ADRD的负担。3)评估高度相关的国家和国家政策对健康的长期影响 HATHAT模型中的老龄化。政策专家将就最相关和最具影响力的政策提供建议以进行评估， 模拟将描绘沿着PCB--&gt；治疗使用--&gt；CMH--&gt；ADRD联系的影响。这件事成功了 该项目可能导致在一系列疾病领域建立审查尚未构思的卫生政策的未来模型。 这将使我处于有利地位，领导一个独立的研究项目，通过以下方式影响未来的政策 确定多氯联苯和获得护理与长期健康老龄化和ADRD之间的关系。

Patient cost burden (PCB) for healthcare, as influenced by the rapidly changing health policy landscape, is a common patient-reported outcome for uninsured individuals and enrollees in high deductible health plans (HDHPs, 30% of employer-sponsored plans). In these contexts, PCB has important effects on adherence to medications that help manage cardiovascular and metabolic health (CMH). The management of CMH, including type 2 diabetes mellitus (T2DM), is an important part of healthy aging, and affects risk of Alzheimer's disease and related dementias (ADRD). In order to understand the long-term consequences of today's PCB on the healthy aging and ADRD risk of tomorrow, it is critical to develop methods and models that can simulate the complicated interplay between PCB, medication adherence, and ADRD. The proposed work in this application builds upon my experience investigating effects of insurance design and pharmacoepidemiology of ADRD, and enhances it by adding training in areas that are critical to achieving my long-term career goal: to become a leading independent investigator of the relationships between health policies and the burden of chronic diseases. The training of this award includes development and application of simulation models of healthcare interventions, policy and stakeholder engagement, T2DM and ADRD, geriatric research and care, and leadership. The newly acquired skills and knowledge obtained are necessary to conduct the proposed research, which aims to examine the effects of PCB on management of T2DM, and simulating how health policies that influence PCB affect the burden of ADRD. With mentorship from established leaders in simulation modeling, geriatrics, health economics, health policy, ADRD, and T2DM, I will accomplish the following specific aims: 1) Simulate long-term effects of PCB on T2DM management and progression using the Real-World Progression in Diabetes Model (RAPIDS). PCB will be examined in the context of uninsurance and HDHPs, and we will simulate how effects of PCB on T2DM management translate into long-term CMH outcomes in RAPIDS, a validated model of T2DM progression. 2) Build a new simulation model using a near-elderly/elderly lifetime perspective to connect PCB, T2DM progression, and ADRD incidence and burden. The new Healthcare Access Today and Healthy Aging Tomorrow (HATHAT) Model will connect the RAPIDS Model to the validated Future Elderly Model (FEM), in order to comprehensively relate PCB, T2DM treatments, micro- and macro- vascular events, and biomarkers to the future burden of ADRD. 3) Evaluate long-term consequences of highly relevant state and national policies on healthy aging in the HATHAT Model. Policy experts will advise on the most relevant and impactful policies to evaluate, and simulations will delineate effects along the PCB-->Treatment Use-->CMH-->ADRD nexus. Success of this project can lead to future models that examine health policies yet to be conceived, in a range of disease areas. This will leave me well-positioned to lead an independent research program that influences future policy by identifying how PCB and access to care relate to long-term healthy aging and ADRD.