Developing and Testing a Population Health Approach to Deprescribing and Optimizing Medications in Older Adults

开发和测试人口健康方法以减少和优化老年人的药物治疗

• 批准号: 10428280
• 负责人: Michelle Sophie Keller
• 金额: $ 12.49万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10428280
• 关键词: Address; Adult; Adverse event; Age; Alzheimer' s disease related dementia; Appointment; Caregivers; Caring; Case Manager; Cessation of life; Cholesterol; Chronic; Chronic Disease; Clinical Trials; Contracts; Data; Data Analyses; Data Element; Development; Diabetes Mellitus; Doctor of Philosophy; Elderly; Electronic Health Record; Emergency department visit; Enrollment; Environment; Face; Future; Geriatrics; Health Care Costs; Health Personnel; Health Services; Health system; Healthcare Systems; Hemorrhage; High Prevalence; Hospitalization; Hypertension; Impaired cognition; Informatics; Infrastructure; Inpatients; Intervention; K-Series Research Career Programs; Life Style; Limited English Proficiency; Measures; Medicare; Medication Management; Mentors; Modeling; Monitor; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacoepidemiology; Pharmacy facility; Physicians; Polypharmacy; Population; Pragmatic clinical trial; Primary Care Physician; Provider; Quality of life; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Registries; Reproducibility; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Science; Testing; Time; Training; Validation; Visit; Work; acceptability and feasibility; adverse drug reaction; base; beneficiary; career; career development; community intervention; cost; cost effective; design; diabetes management; effectiveness evaluation; experience; fall risk; falls; feasibility testing; frailty; health care service utilization; high risk; improved; mortality; multidisciplinary; outreach; pilot test; population health; pressure; prevent; primary outcome; professor; programs; risk prediction model; side effect

PROJECT SUMMARY Michelle S. Keller, PhD, MPH is a health services researcher with Assistant Professor appointments at Cedars- Sinai Health System (CSHS) and UCLA. Dr. Keller’s research focuses on reducing inappropriate medication use in older adults, particularly in populations with high levels of medication use, such as older adults with Alzheimer’s Disease and Related Dementias (ADRD). Reducing inappropriate medication use in older adults has been shown to reduce mortality, but evidence is limited on whether interventions that reduce inappropriate medications reduce hospitalizations and emergency department visits. More than half of older adults in the U.S. receive their care from health systems and provider groups which contract with Medicare Advantage plans or are part of Accountable Care Organizations, organizations which are financially accountable for Medicare beneficiaries’ health costs. These organizations proactively manage chronic conditions such as diabetes, hypertension, and high cholesterol to prevent unnecessary avoidable hospitalizations. This proposal aims to create a similar approach to managing medication use through the development and validation of a risk prediction model and registry that identifies older adults with a large number of potentially inappropriate medications and other conditions that place older adults at risk for hospitalization, including age, cognitive decline, frailty, and risk of falls. This proposal will use this registry and risk model as part of a feasibility and acceptability study to identify, refer, and enroll older adults with ADRD in a pharmacist-led medication review intervention aimed at reducing inappropriate medications. Dr. Keller’s career development and training plan includes coursework in embedded, pragmatic clinical trials and geriatrics. Dr. Keller will accomplish the proposed research and training aims with the support of a strong multi-disciplinary mentoring team from UCLA and CSHS: Catherine Sarkisian (geriatrics and deprescribing), Zaldy Tan (ADRD) Teryl Nuckols (health systems science), Joshua Pevnick (medication management), and Nicole Brandt (pharmacy and deprescribing). These efforts will be supported by the outstanding research environment and infrastructure of CSHS and UCLA. Given the strong mentoring, institutional, and infrastructure supports in place, the proposed K award program is ideally designed to provide the PI with the experience needed to launch her career as an independent investigator and future leader in deprescribing research.

项目摘要 米歇尔·S凯勒，博士，公共卫生硕士是一个健康服务研究员与助理教授任命雪松- 西奈卫生系统（CSHS）和加州大学洛杉矶分校。凯勒博士的研究重点是减少不适当的药物使用 在老年人中，特别是在药物使用水平高的人群中，如老年痴呆症患者 疾病及相关痴呆（ADRD）。减少老年人不适当的药物使用， 显示出降低死亡率，但证据有限，是否干预，减少不适当的药物， 减少住院和急诊。在美国，超过一半的老年人接受他们的医疗服务。 与Medicare Advantage计划签订合同或属于 责任医疗组织，即在财务上对Medicare受益人负责的组织。 医疗费用。这些组织积极主动地管理慢性疾病，如糖尿病，高血压， 高胆固醇，以防止不必要的可避免的住院治疗。该提案旨在建立一个类似 通过开发和验证风险预测模型来管理药物使用的方法， 登记处，确定老年人与大量潜在的不适当的药物和其他 使老年人有住院风险的条件，包括年龄、认知能力下降、虚弱和 福尔斯。该提案将使用该登记和风险模型作为可行性和可接受性研究的一部分，以识别， 转诊并招募患有ADRD的老年人参加药剂师领导的药物审查干预，旨在减少 不适当的药物。凯勒博士的职业发展和培训计划包括嵌入式， 实用的临床试验和老年医学。凯勒博士将完成拟议的研究和培训目标， 来自加州大学洛杉矶分校和CSHS的强大的多学科指导团队的支持：Catherine Sarkisian（老年医学 Zaldy Tan（ADRD）Teryl Nuckols（卫生系统科学），约书亚Pevnick（药物 管理）和妮可·勃兰特（药房和开处方）。这些努力将得到 优秀的研究环境和基础设施的CSHS和加州大学洛杉矶分校。在强大的指导下， 机构和基础设施支持到位，拟议的K奖计划是理想的设计，以提供 PI具有开展其职业生涯所需的经验，作为独立研究者和未来的领导者， 撤销研究处方。