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

项目总结 米歇尔·S·凯勒博士，公共卫生硕士，卫生服务研究员，在雪松大学担任助理教授- 西奈医疗系统(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，例如患有阿尔茨海默氏症的老年人 疾病及相关痴呆(ADRD)。减少老年人不适当的药物使用一直是 显示可以降低死亡率，但证据有限，关于减少不适当药物使用的干预措施 减少住院和急诊科就诊。在美国，超过一半的老年人收到了 来自与Medicare Advantage计划签约或属于以下计划一部分的医疗系统和提供者团体的护理 负责任的护理组织，对医疗保险受益人负有财务责任的组织 医疗费用。这些组织积极主动地管理糖尿病、高血压和 高胆固醇，以防止不必要的住院治疗。这项提案旨在创建类似的 通过风险预测模型的开发和验证来管理用药的方法 确定老年人是否服用了大量可能不适当的药物和其他 使老年人面临住院风险的条件，包括年龄、认知能力下降、虚弱和 瀑布。该提案将使用这一登记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， 推荐患有ADRD的老年人，并让他们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Embedded、 务实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(老年病学 和停药)，Zaldy Tan(ADRD)Teryl Nuckols(卫生系统科学)，Joshua Pevnick(药物 管理)和妮可·勃兰特(药房和停药)。这些努力将得到 CSHS和UCLA优秀的研究环境和基础设施。考虑到强有力的指导， 机构和基础设施支持到位，拟议的K奖励计划旨在提供 这位私家侦探拥有作为独立调查员和未来的领导者开始职业生涯所需的经验 取消研究处方。

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.