Hierarchical models of prescription drug use in the elderly

描述（由申请人提供）：本提案中概述的指导研究和培训的五年计划旨在将生物统计学家Brookhart博士培养为在老年医学，生物统计学和药物流行病学交叉领域工作的独立调查员。本提案的主要研究目的是开发和应用分层统计模型，用于研究老年人使用处方药的复杂模式，这是一个具有重要临床和政策意义的领域。可用于了解药物使用的数据具有多层次结构，包括对聚集在医生，实践和地理区域内的患者的重复观察。为了捕捉复杂的数据结构，并回答重要的实质性问题，处方药使用的老年患者，我们建议采用现代统计方法进行分层数据的分析。随着人们对处方药的适当使用和成本的日益关注，特别是新的医疗保险药物福利，这种处方和依从性模式可以在改善药物使用方面发挥重要作用。通过了解处方药使用的常见模式，可以设计有针对性的和具有成本效益的质量改进干预措施。在该奖项的最后阶段，候选人将开发多层次的统计方法，用于创建患者，医生，实践和区域配置文件，可用于目标质量改进干预措施，旨在促进更适当的处方和更高水平的患者坚持有效的治疗。不同的剖析方法将作为未来R 01提案的一部分进行试点测试和比较。本提案中概述的指导研究将得到正式培训计划的补充，该培训计划将涉及老年学、老年病学、慢性病流行病学、健康行为理论、处方药和医疗保健政策以及卫生服务研究等课程;与导师和其他高级教师定期举行会议;出席研讨会、讲习班和学术会议;以及系统性暴露于临床老年病，包括在门诊、住院和长期护理环境中花费的时间。

DESCRIPTION (provided by applicant): The five year program of mentored research and training outlined in this proposal is designed to develop Dr. Brookhart, a biostatistician, into an independent investigator working at the intersection of geriatrics, biostatistics, and drug epidemiology. The primary research aim of this proposal is the development and application of hierarchical statistical models for the study of complex patterns of prescription drug use by the elderly, an area of great clinical and policy importance. The data that are available to understand medication use have a multilevel structure consisting of repeated observations on patients who cluster within physicians, practices, and geographic regions. To capture the complex structure of the data and answer important substantive questions about prescription drug use by older patients, we propose to employ modern statistical approaches for the analysis of hierarchical data. With increasing concern over the appropriate use and cost of prescription drugs, particularly with the new Medicare drug benefit, such models of prescribing and adherence can play an important role in improving the use of medications. By understanding common patterns of prescription medication use, targeted and cost-effective quality improvement intervention can be designed. In the final phase of this award the candidate will develop multilevel statistical approaches for creating patient, physician, practice, and region profiles that can be used to target quality improvement interventions that aim to promote more appropriate prescribing and higher levels of patient adherence to effective therapies. Different profiling approaches will be pilot tested and compared as part of a future R01 proposal. The mentored research outlined in this proposal will be complemented by a formal training program that will involve coursework in gerontology, geriatrics, chronic disease epidemiology, theories of health behavior, prescription drug and health care policy, and health services research; regular meetings with mentors and other senior faculty; attendance at seminars, workshops, and academic conferences; and systematic exposure to clinical geriatrics including time spent in outpatient, inpatient, and long-term care environments.