权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Decision Making for Cardiovascular Therapy in Adults with Mild Cognitive Impairment

轻度认知障碍成人心血管治疗的决策

基本信息

批准号：
9519775
负责人：
Deborah Levine
金额：
$ 72.37万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9519775
关键词：
Activities of Daily Living Acute Acute myocardial infarction Address Adult Affect Aftercare American Cardiovascular Diseases Cardiovascular system Caring Clinical Cognitive Complex Data Data Analyses Decision Making Dementia Development Elderly Event Face Goals Guidelines Hand Health Health Services Research Health and Retirement Study Heart Human Impaired cognition Intervention Interview Ischemic Stroke Knowledge Lead Life Expectancy Link Longitudinal cohort Measures Medicare Methods Michigan Mission Modeling Morbidity - disease rate Outcome Patient Preferences Patient-Focused Outcomes Patients Physicians Population Public Health Quality of life Recommendation Rehabilitation therapy Research Research Proposals Risk Secondary Prevention Secondary to Stroke Structure Surveys Testing Time Translating Treatment outcome United States National Institutes of Health Universities Work advanced dementia cardiovascular disorder risk care outcomes clinical decision-making cohort design disability effective therapy experience improved innovation mild cognitive impairment mortality novel strategies older patient population based preference prevent public health relevance standard care stroke treatment therapy design

项目摘要

DESCRIPTION (provided by applicant): There is a fundamental gap in understanding how mild cognitive impairment (MCI) influences treatment and decision making for serious illnesses, like cardiovascular disease (CVD), in older patients. Poor understanding of clinical decision making is a critical barrier to the design of interventions to improve the quality and outcomes of CVD care of in older patients with MCI. The long-term goal of this research is to develop, test, and disseminate interventions aimed to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans with MCI. The objective of this application is to determine the extent to which people with MCI are receiving sub-standard care for the two most common CVD events, acute myocardial infarction (AMI) and acute ischemic stroke, increasing the chance of mortality and morbidity in a population with otherwise good quality of life, and to determine how MCI influences patient preferences and physician recommendations for treatment. AMI and acute ischemic stroke are excellent models of serious, acute illnesses with a wide range of effective therapies for acute management, rehabilitation, and secondary prevention. Our central hypothesis is that older adults with MCI are undertreated for CVD because patients and physicians overestimate their risk of dementia and underestimate their risk of CVD. This hypothesis has been formulated on the basis of preliminary data from the applicants' pilot research. The rationale for the proposed research is that understanding how patient preferences and physician recommendations contribute to underuse of CVD treatments in patients with MCI has the potential to translate into targeted interventions aimed to improve the quality and outcomes of care, resulting in new and innovative approaches to the treatment of CVD and other serious, acute illnesses in adults with MCI. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Compare AMI and stroke treatments between MCI patients and cognitively normal patients and explore differences in clinical outcomes associated with treatment differences; and 2) Determine the influence of MCI on patient and surrogate preferences and physician recommendations for AMI and stroke treatment. Under the first aim, a health services research approach- shown to be feasible in the applicants' hands-will be used to quantify the extent and outcomes of treatment differences for AMI and acute ischemic stroke in older patients with MCI. Under the second aim, a multi-center, mixed-methods approach and a national physician survey, which also has been proven as feasible in the applicants' hands, will be used to determine the influence of MCI on patient preferences and physician recommendations for AMI and stroke treatment. This research proposal is innovative because it represents a new and substantially different way of addressing the important public health problem of enhancing the health of older adults by determining the extent and causes of underuse of effective CVD treatments in those with MCI. The proposed research is significant because it is expected to vertically advance and expand understanding of how MCI influences treatment and decision making for AMI and ischemic stroke in older patients. Ultimately, such knowledge has the potential to inform the development of targeted interventions that will help to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans.

描述（由申请人提供）：在了解轻度认知障碍（MCI）如何影响老年患者心血管疾病（CVD）等严重疾病的治疗和决策方面存在根本性差距。对临床决策的理解不足是设计干预措施以改善MCI老年患者CVD护理质量和结局的关键障碍。这项研究的长期目标是开发、测试和传播干预措施，旨在提高心血管疾病护理的质量和结果，并减少患有MCI的美国老年人的心血管疾病相关残疾。本申请的目的是确定MCI患者接受两种最常见的CVD事件（急性心肌梗死（AMI）和急性缺血性卒中）的不达标治疗的程度，增加了其他生活质量良好的人群的死亡率和发病率，并确定MCI如何影响患者偏好和医生的治疗建议。AMI和急性缺血性卒中是严重急性疾病的极好模型，具有广泛的急性管理、康复和二级预防的有效疗法。我们的中心假设是，患有MCI的老年人对CVD治疗不足，因为患者和医生高估了他们患痴呆症的风险，低估了他们患CVD的风险。这一假设是根据申请人试点研究的初步数据提出的。拟议研究的基本原理是，了解患者偏好和医生建议如何导致MCI患者CVD治疗使用不足，有可能转化为旨在提高护理质量和结果的有针对性的干预措施，从而产生新的创新方法来治疗MCI成人的CVD和其他严重急性疾病。在强有力的初步数据的指导下，该假设将通过追求两个特定目标进行检验：1）比较MCI患者和认知正常患者之间的AMI和卒中治疗，并探索与治疗差异相关的临床结局差异; 2）确定MCI对患者和替代偏好以及医生对AMI和卒中治疗建议的影响。在第一个目标下，将使用一种卫生服务研究方法（在申请人手中证明是可行的）来量化老年MCI患者中AMI和急性缺血性卒中治疗差异的程度和结果。在第二个目标下，多中心，混合方法的方法和全国医生调查，这也被证明是可行的，在申请人的手中，将被用来确定MCI对患者的偏好和医生的建议AMI和中风治疗的影响。这项研究提案是创新的，因为它代表了一种新的和实质上不同的方式，通过确定MCI患者有效CVD治疗使用不足的程度和原因，来解决提高老年人健康的重要公共卫生问题。这项研究意义重大，因为它有望垂直推进和扩大对MCI如何影响老年患者AMI和缺血性卒中治疗和决策的理解。最终，这些知识有可能为制定有针对性的干预措施提供信息，这将有助于提高CVD护理的质量和结果，并减少美国老年人中CVD相关的残疾。