Physician Screening of Older Drivers: Decision Rules for Geriatric Injury Prevent

描述(由申请人提供)：这是由玛丽安·贝茨，医学博士，公共卫生硕士重新提交的保罗·B·比森以患者为导向的老年研究职业发展奖(K23)的重新提交。贝茨博士的总体职业目标是成为老年损伤预防领域的领先独立研究人员 和急救药物，以帮助保持老年人的功能独立。她的创新研究建议将临床决策规则的模型应用于公共卫生干预，通过对门诊护理环境中简要的老年司机筛查进行分级评估，然后转诊进行更全面的测试。候选人：贝茨博士是董事会认证的急诊内科医生、科罗拉多大学丹佛分校(UCD)医学院急诊医学助理教授和科罗拉多公共卫生学院流行病学助理教授。她完成了公共卫生硕士和急诊医学基金会研究奖学金，并完成了一些与老年司机和伤害流行病学和预防有关的研究。贝茨博士与她的主要导师(罗伯特·施瓦茨博士，老年病学领域的领先研究员，有长期的指导记录)和共同导师(大卫·卡尔博士，全国老年驾驶问题专家和研究员)、研究方法论(Jason Haukoos博士，擅长临床决策规则方法学的研究人员)和定性方法(Jaqueline Jones博士，专注于老年人和急救医学的定性研究人员)建立了密切的工作关系。培训：拟议的职业发展计划加强了Betz博士先前的培训和经验，侧重于以下方面的具体高级培训：(1)定性研究方法；(2)决策规则的推导、验证和实施；(3)老年损伤预防方面的公共卫生问题；以及(4)研究管理和领导力。贝茨博士建议通过密集而专注的指导、相关的高级课程和指导性研究来获得这些技能。这些培训活动将帮助贝茨博士获得必要的技能和知识，以实施有效的分级老年司机评估计划，在临床环境中进行简单的筛查，然后适当地转介到更全面的司机评估计划。导师/环境：Betz博士拥有一支由老年病学、驾驶、研究方法、伤害预防和急救医学领域的领导者组成的强大导师团队，他们致力于在她成长为独立调查员的过程中指导她完成研究和职业发展活动。此外，一个由老年医学专家组成的顾问小组， 除了提供额外的局部指导外，贝茨博士的受伤和研究生涯发展还将监测他的进展。急诊医学部致力于支持Betz博士成长为一名独立的研究人员，包括为她参与竞争激烈的科罗拉多州临床和转化科学研究所(CCTSI)临床学院学者计划提供资金和时间支持(并对初级研究人员进行密集指导)，以及承诺为这一职业发展奖提供受保护的时间和资源。此外，UCD为Betz博士提供了丰富的研究环境，包括获得CCTSI、UCD跨学科老龄中心以及UCD医学、公共卫生、护理和其他学科专业学院的资源和合作者。研究：随着美国人口老龄化，迫切需要高效、有效和可接受的方法来识别、再培训或限制不安全的老年司机，同时又不公平地限制安全司机的行动。这项提案将临床决策规则的模式应用于公共卫生计划，通过制定分级的老年司机评估，进行广泛的简短筛查，然后转介对筛查阳性的司机进行额外评估。该研究计划旨在审查老年司机和服务提供者对驾驶员评估的观点(目标1)，验证和完善一个简短的基于问题的筛查工具(目标2)，并检查试点计划实施的可行性(目标3)，以便为未来实施模式分级老年司机评估计划(计划的R01)做准备。摘要：这一创新建议将临床医学(临床决策规则)中的通用方法应用于老年伤害预防(老年驾驶员安全)中的一个重要问题，并以一种考虑和重视老年驾驶员、其家人和提供者的观点的方式来确保老年驾驶员的安全。这种方法可能适用于其他老年损伤或其他环境，拟议的有指导的、以患者为中心的培训和研究将帮助贝茨博士发展成为一名独立的、国家认可的老年损伤预防研究员和领导者。

DESCRIPTION (provided by applicant): This is a resubmission for a Paul B. Beeson Patient-Oriented Research Career Development Award in Aging (K23) by Marian Betz, MD, MPH. Dr. Betz's overall career goal is to be a leading independent researcher in geriatric injury prevention and emergency medicine in order to help maintain functional independence in older adults. Her innovative research proposal applies the model of a clinical decision rule to a public health intervention, through tiered assessment of brief older driver screening in ambulatory care settings followed by referral for more comprehensive testing. Candidate: Dr. Betz is a board-certified Emergency Medicine physician, Assistant Professor of Emergency Medicine at the University of Colorado Denver (UCD) School of Medicine and Assistant Professor of Epidemiology at the Colorado School of Public Health. She completed a Masters of Public Health and the Emergency Medicine Foundation Research Fellowship, and she has finished a number of studies related to older drivers and injury epidemiology and prevention. Dr. Betz has established close working relationships with her primary mentor (Dr. Robert Schwartz, a leading researcher in geriatrics with a long track record of mentoring) and co-mentors in Driving (Dr. David Carr, a national expert and researcher on older driver issues), Research Methodology (Dr. Jason Haukoos, a researcher with expertise in clinical decision rule methodology) and Qualitative Methods (Dr. Jaqueline Jones, a qualitative researcher with a focus on older adults and emergency medicine). Training: The proposed career development plan augments Dr. Betz's prior training and experience to focus on specific, advanced training in: (1) qualitative research methods; (2) decision rule derivation, validation and implementation; (3) public health issues in geriatric injury prevention; and (4) study management and leadership. Dr. Betz proposes to acquire these skills through intensive focused mentorship, relevant advanced coursework, and guided research. These training activities will help Dr. Betz gain the necessary skills and knowledge to implement an effective tiered older driver assessment program with brief screening in a clinical setting followed by appropriate referral to more comprehensive driver evaluation programs. Mentors/Environment: Dr. Betz has a strong mentorship team of leaders in geriatrics, driving, research methods, injury prevention, and emergency medicine who are committed to guiding her through her research and career development activities as she develops into an independent investigator. In addition, an advisory panel of experts in geriatrics, injury, and research career development will monitor Dr. Betz's progress in addition to providing additional topical guidance. The Department of Emergency Medicine is committed to supporting Dr. Betz's growth into an independent researcher, including financial and time support for her participation in the competitive Colorado Clinical and Translational Sciences Institute (CCTSI) Clinical Faculty Scholars Program (with intensive mentoring of junior research faculty) and a commitment of protected time and resources for this career development award. In addition, the UCD provides Dr. Betz with a rich research environment, including access to resources and collaborators at the CCTSI, the interdisciplinary UCD Center on Aging, and the UCD professional Schools of Medicine, Public Health, Nursing, and other disciplines. Research: With the aging of the U.S. population, there is an urgent need for efficient, effective and acceptable methods of identifying, retraining or restricting unsafe older drivers without unfairly restrictingthe mobility of those who are safe. This proposal applies the model of a clinical decision rule to a public health program through the development of tiered older driver assessment, with widespread brief screening followed by referral for additional evaluation of those with a positive screen. The research plan aims to examine the viewpoints of older drivers and providers concerning driver assessment (Aim 1), to validate and refine a brief question-based screening tool (Aim 2), and to examine the feasibility of pilot program implementation (Aim 3) in order to prepare for future implementation of a model tiered older driver assessment program (planned R01). Summary: This innovative proposal applies a common approach from clinical medicine (clinical decision rules) to an important issue in geriatric injury prevention (older driver safety in a way that considers and values the perspectives of older drivers, their families, and their providers. This approach might be applied to other geriatric injuries or other settings, and the proposed mentored, patient-centered training and research will help Dr. Betz develop into an independent, nationally-recognized investigator and leader in geriatric injury prevention.