Treatment Burden in Complex Older Patients as a Target for Intervention

以复杂老年患者的治疗负担为干预目标

• 批准号: 7535145
• 负责人: CYNTHIA Melinda BOYD
• 金额: $ 15.44万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7535145
• 关键词: Treatment; Burden; Complex; Older; Patients

DESCRIPTION (provided by applicant): Complex older patients present substantial challenges to delivering medical care that is both guideline-based and patient-centered. There is little information available to guide a patient with complex health status and his or her physicians when they weigh the risks, burdens and benefits of a test or treatment plan to diagnose or treat chronic diseases. Despite the known relevance of treatment burden to patients' medical decision-making and quality of life in the settings of single diseases and at the end of life, there are no measures to assess treatment burden that can be used to improve patient-centered decision-making for patients with multiple chronic diseases. Treatment burden is defined in this application as the aggregate weight of the actions and resources patients and caregivers devote to health care management tasks, including effort, time, and out-of-pocket costs. Understanding the treatment burden experienced by complex patients is essential to delivering prioritized, patient-centered medical care. We propose to identify how complex health status is associated with treatment burden, operationalized as the presence and magnitude of self- reported difficulty with heath care management tasks, in multimorbid patients. We further investigate whether patient activation modifies this relationship, and, how treatment burden is related to health-related quality of life and quality of care using both cross-sectional and longitudinal data analyses. Specifically, we propose to use data from an ongoing study of older, multimorbid adults to investigate the following aims: 1) how different patterns of co-existing conditions are associated with treatment burden, 2) the association between presence and magnitude of treatment burden, and a) physical and mental-health related quality of life, and b) patient-reported quality of chronic illness care, and 3) the relationship between a) changes in patient activation and changes in treatment burden, and b) changes in treatment burden and changes in physical and mental health-related quality of life, and c) changes in treatment burden and changes in the ratings of patient-reported quality of chronic illness care over 18 months. If study hypotheses are substantiated, this study will lay the necessary ground work to develop an intervention consisting of assessing, reducing and managing treatment burden to improve patient-centered decision-making, which in turn should benefit adherence, physician-patient communication, health-related quality of life and quality of care.

描述（由申请人提供）：复杂的老年患者对提供基于指南和以患者为中心的医疗护理提出了重大挑战。当医生权衡诊断或治疗慢性病的测试或治疗计划的风险、负担和益处时，几乎没有信息可用于指导健康状况复杂的患者及其医生。尽管已知治疗负担与患者在单一疾病和生命末期的医疗决策和生活质量相关，但没有评估治疗负担的措施可用于改善患有多种慢性疾病的患者以患者为中心的决策。在本申请中，治疗负担定义为患者和护理人员用于医疗保健管理任务的行动和资源的总权重，包括努力、时间和自付费用。了解复杂患者所经历的治疗负担对于提供优先的、以患者为中心的医疗护理至关重要。我们建议确定复杂的健康状况如何与治疗负担相关，可操作性为多病患者自我报告的健康护理管理任务困难的存在和程度。我们进一步研究患者激活是否改变了这种关系，以及如何治疗负担与健康相关的生活质量和护理质量的横向和纵向数据分析。具体而言，我们建议使用正在进行的老年多病成人研究的数据来调查以下目标：1）不同模式的共存疾病如何与治疗负担相关，2）治疗负担的存在和程度之间的关联，以及a）身体和精神健康相关的生活质量，和B）患者报告的慢性病护理质量，和3）a）患者激活的变化和治疗负担的变化之间的关系，和B）治疗负担的变化和身体和精神健康相关的生活质量的变化之间的关系，和c）治疗负担的变化和18个月内患者报告的慢性病护理质量的评级的变化之间的关系。如果研究假设得到证实，这项研究将奠定必要的基础工作，以制定一项干预措施，包括评估，减少和管理治疗负担，以改善以患者为中心的决策，这反过来又有利于坚持，医患沟通，健康相关的生活质量和护理质量。