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

受快速变化的卫生政策环境的影响，医疗保健的患者成本负担（PCB）是一个 无保险个人和高免赔额健康计划参加者的常见患者报告结局 （HDHPs，雇主赞助计划的30%）。在这些情况下，多氯联苯对遵守 帮助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，并影响阿尔茨海默病的风险 和相关痴呆症（ADRD）。为了了解当今PCB对环境的长期影响， 健康老龄化和ADRD风险的明天，关键是要开发的方法和模型，可以模拟 PCB，药物依从性和ADRD之间的复杂相互作用。本申请中的拟议工作 基于我调查保险设计和药物流行病学对ADRD影响的经验， 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员。 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，老年医学研究和护理，以及领导力。新 获得的技能和知识是进行拟议研究所必需的，其目的是检查 多氯联苯对2型糖尿病管理的影响，并模拟影响多氯联苯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、 健康政策，ADRD和T2 DM，我将实现以下具体目标：1）模拟长期影响， PCB使用真实世界糖尿病进展模型（急流）进行T2 DM管理和进展。 多氯联苯将在不保险和HDHPs的背景下进行研究，我们将模拟多氯联苯对 在急流（一种经验证的T2 DM进展模型）中，T2 DM管理转化为长期CMH结局。 2)构建一个新的模拟模型，使用近老年人/老年人的终身视角来连接PCB，T2 DM 进展和ADRD发病率和负担。今天的新医疗保健服务和明天的健康老龄化 （HATHAT）模型将急流模型连接到经过验证的未来老年人模型（FEM），以便 全面地将PCB、T2 DM治疗、微血管和大血管事件以及生物标志物与未来联系起来 ADRD的负担3)评估高度相关的州和国家健康政策的长期后果 HATHA模型中的老化。政策专家将就最相关和最具影响力的政策提供建议， 并且模拟将描绘沿着PCB-->治疗使用-->CMH-->ADRD关系的效应沿着。成功的这项 该项目可以导致未来的模式，审查卫生政策尚未设想，在一系列疾病领域。 这将使我有能力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PCB和获得护理与长期健康老龄化和ADRD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.