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.

项目概要 米歇尔·S·凯勒 (Michelle S. Keller) 博士、公共卫生硕士是一名卫生服务研究员，在 Cedars- 担任助理教授 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 老年人，特别是药物使用率较高的人群，例如患有阿尔茨海默病的老年人 疾病和相关痴呆症（ADRD）。减少老年人的不当药物使用 研究显示可以降低死亡率，但关于是否可以减少不适当药物治疗的干预措施的证据有限 减少住院和急诊就诊。超过一半的美国老年人接受了 来自与 Medicare Advantage 计划签订合同或属于其中一部分的卫生系统和提供者团体的护理 责任医疗组织，对医疗保险受益人承担财务责任的组织 健康成本。这些组织主动管理慢性病，如糖尿病、高血压和 高胆固醇，以防止不必要的可避免的住院治疗。该提案旨在创建一个类似的 通过开发和验证风险预测模型来管理药物使用的方法 登记册，识别患有大量潜在不适当药物和其他药物的老年人 使老年人面临住院风险的情况，包括年龄、认知能力下降、虚弱和患病风险 瀑布。该提案将使用此注册和风险模型作为可行性和可接受性研究的一部分，以确定： 转诊并让患有 ADRD 的老年人参加药剂师主导的药物审查干预措施，旨在减少 不适当的药物。 Keller 博士的职业发展和培训计划包括嵌入式、 务实的临床试验和老年病学。凯勒博士将完成拟议的研究和培训目标 加州大学洛杉矶分校 (UCLA) 和 CSHS 强大的多学科指导团队的支持：Catherine Sarkisian（老年病学） 和取消处方）、Zaldy Tan (ADRD) Teryl Nuckols（卫生系统科学）、Joshua Pevnick（药物治疗） 管理）和 Nicole Brandt（药房和处方药）。这些努力将得到以下机构的支持 CSHS和UCLA优秀的研究环境和基础设施。在强有力的指导下， 机构和基础设施支持到位，拟议的 K 奖计划旨在提供 PI 拥有作为独立调查员和未来领导者开启职业生涯所需的经验 取消研究。