Efficiency of Tailoring Treatment to Smoker Subgroup

描述(申请人提供)：本K07癌症预防建议书， 控制和人口科学将使申请者能够将两个 进入商业管理和临床心理学领域的研究生涯 成本效益高的一级和二级癌症预防传播 干预措施。目标是：a)在以下方面获得干预经验 难以治疗的吸烟者；b)建立经济、社会和文化统计方法的知识 研究；c)将管理科学的方法应用于成本研究-- 效率；以及，d)制定关于传播的方案方针和研究 以及癌症预防和控制干预措施的成本效益。 通过戒烟来预防癌症涉及到一个悖论。低成本/低成本 强度/效率低的公共卫生方法具有更大的覆盖面，而 成本/高强度/低覆盖的临床干预措施具有更好的疗效。 对于难以治疗的吸烟者来说，疗效差异最大的是 更严重的尼古丁依赖、抑郁和酗酒问题。 最近，一些人呼吁整合这些截然不同的干预措施 通过使用定制的分步护理模式实现成本最大化的方法- 高效配置医疗保健资源。其中的研究计划 职业发展提案要求进行两项研究，即电子胺成本和 针对吸烟者亚群的效率。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年全国死亡率回溯调查(N=22,957)至 检查高危吸烟者亚群的医疗利用情况 饮酒、久坐不动的生活方式或抑郁。医疗费用 使用率将根据医疗支出小组的数据进行估计 调查。研究1假设吸烟与其他健康风险相互作用 预测吸烟者亚群更大成本的因素。研究2将 检查电话的成本效益和运营效率 量身定做的吸烟干预措施。研究2假设量身定做 干预措施将比更标准化的干预措施更具成本效益， 特别是在有其他高危因素的吸烟者中。研究2还将 使用管理科学的工具来评估临床系统因素 影响干预效率。这些研究将为未来提供信息 低成本、高效果戒烟的传播研究 解决提供医疗保健的经济必要性的干预措施 在最大限度地造福于公众健康的同时，加强公共卫生系统的建设。

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.