Efficiency of Tailoring Treatment to Smoker Subgroup

描述（由申请人提供）：该K 07在癌症预防方面的提案， 控制和人口科学将使申请人能够整合两个 领域--商业管理和临床心理学--进入研究生涯 成本效益高的初级和二级癌症预防传播 干预措施。 目标是：（a）获得干预经验， 难以治疗的吸烟者; B）建立经济统计方法的知识 研究; c）将管理科学的方法应用于成本研究， （d）制定方案路线并研究传播问题 以及癌症预防和控制干预措施的成本效益。 通过戒烟预防癌症涉及一个悖论。 低成本/低 密集/低效公共卫生方法的覆盖面更广，而高强度/低效公共卫生方法的覆盖面更广， 成本/高强度/低覆盖面的临床干预措施具有更大的功效。 对于那些难以治疗的吸烟者来说， 尼古丁依赖、抑郁和酗酒的程度更高。 最近，一些人呼吁将这些截然不同的干预措施结合起来 通过使用量身定制的分步护理模式，最大限度地提高成本， 有效配置医疗资源。 这份研究计划 职业发展提案要求进行两项研究，即E胺的成本和 针对吸烟者子集的效率。 研究1将使用来自 1997-1999年全国健康访谈调查的成年受访者（N = +/-100，000）和1993年全国死亡率追踪调查（N = 22，957）， 检查高风险吸烟者的医疗利用情况， 饮酒、久坐不动的生活方式或抑郁症。 医疗费用 将根据医疗支出小组的数据估计使用情况 调查. 研究1假设吸烟与其他健康风险相互作用 预测吸烟者亚组成本更高的因素。 研究2将 研究以电话为本的服务的成本效益及运作效率， 量身定制的吸烟干预措施。 研究2假设， 干预措施将比更标准化的措施更具成本效益， 特别是在有其他高危因素的吸烟者中。 研究2也将 运用管理科学的工具来评估临床系统因素 影响干预效率。 这些研究将为未来的 宣传研究戒烟的成本效益和有效性 解决医疗保健提供的经济必要性的干预措施 系统，同时最大限度地提高公共卫生效益。

DESCRIPTION (provided by applicant): This K07 proposal in cancer prevention, control, and population sciences will enable the applicant to integrate two areas--business management and clinical psychology--into a research career on cost-efficient dissemination of primary and secondary cancer prevention interventions. The goals are to: a) gain experience in interventions for hard-to-treat smokers; b) build knowledge of statistical methods in economic research; c) apply methods from management science to research on cost- efficiency; and, d) develop a programmatic line and research on dissemination and cost-efficiency of interventions for cancer prevention and control. Cancer prevention through smoking cessation involves a paradox. Low cost/low intensity/low efficacy public health approaches have greater reach, while high cost/high intensity/low reach clinical interventions have greater efficacy. The difference in efficacy is greatest for hard-to-treat smokers who have greater levels of nicotine dependence, depression and problem alcohol use. Recently, some have called for integration of these contrasting intervention approaches through use of tailored stepped-care models that maximize cost- efficient allocation of healthcare resources. The research plan in this career development proposal calls for two studies that e amine costs and efficiencies of targeting subsets of smokers. Study 1 will use data from adult respondents to the 1997-1999 the National Health Interview Surveys (N = +/- 100,000) and the 1993 National Mortality Followback Survey (N = 22,957) to examine the medical utilization of subgroups of smokers who have high-risk alcohol consumption, sedentary lifestyle or depression. The costs of medical utilization will be estimated with data from the Medical Expenditure Panel Survey. Study 1 hypothesizes that smoking interacts with other health risk factors to predict greater costs for subgroups of smokers. Study 2 will examine the cost-effectiveness and operational efficiency of a telephone based tailored smoking intervention. Study 2 hypothesizes that tailored interventions will be more cost-effective than more standardized ones, particularly among smokers with other high-risk factors. Study 2 will also use tools from management science to evaluate clinical system factors affecting intervention efficiency. These studies will inform future dissemination research on cost-efficient and effective smoking cessation interventions that address the economic imperatives of healthcare delivery systems while maximizing the benefit to public health.