Treatment Burden in Complex Older Patients as a Target for Intervention

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。对于具有复杂健康状况的患者及其医生，在权衡一项检测或治疗计划的风险、负担和益处时，几乎没有可用的信息来指导他们诊断或治疗慢性疾病。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。治疗负担在此应用程序中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，包括工作量、时间和自付费用。了解复杂患者的治疗负担对于提供优先的、以患者为中心的医疗服务至关重要。我们建议确定复杂的健康状况是如何与治疗负担相关联的，在多病患者中，以自我报告的健康保健管理任务困难的存在和程度来操作。我们进一步研究患者激活是否改变了这种关系，以及治疗负担如何与健康相关的生活质量和护理质量相关，使用横断面和纵向数据分析。具体来说，我们建议使用一项正在进行的老年多病成人研究的数据来调查以下目标：1)共存疾病的不同模式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，a)与身心健康相关的生活质量，b)患者报告的慢性病护理质量，以及3)a)患者激活变化与治疗负担变化之间的关系，b)治疗负担变化与身心健康相关的生活质量变化之间的关系。c) 18个月内治疗负担的变化和患者报告的慢性病护理质量评分的变化。如果研究假设得到证实，本研究将为开发一种干预措施奠定必要的基础，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，从而有利于依从性、医患沟通、健康相关的生活质量和护理质量。

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.