MIT Roybal Center for Translational Research to Improve Healthcare for the Aging

摘要 在行为干预方面，并不缺乏创新的想法，以改善卫生保健的提供， 美国的卫生保健提供改革有可能大大改善健康和卫生保健 体验.对于与医疗保健系统互动更多的老龄化人口来说尤其如此 经常遭受一些最严重的健康问题。然而，我们对它知之甚少。 干预措施可以有效改善这些人的健康。这项建议旨在确定， 资助和支持低成本、高影响力的中年和老年人行为干预第一阶段试验。 Abdul Latif Jameel贫困行动实验室（J-PAL）成立于2003年，是一个拥有超过165个附属机构的网络 超过55所大学的教授，通过使用随机评估来回答关键政策， 问题. J-PAL北美（NA）于年在马萨诸塞州理工学院（MIT）推出 2013年，Amy Finkelstein（麻省理工学院）和Lawrence Katz（哈佛）将J-PAL方法应用于该地区。J-PAL NA的卫生保健提供倡议（HCDI）专注于催化高质量的随机对照试验 （RCTs），以测试如何最好地改善医疗保健服务。我们建议利用这一基础， 支持早期随机对照试验，以测试行为干预措施，改善医疗服务和健康结果 对于老年人来说。麻省理工学院罗伊巴尔中心将在第一年支持两个第一阶段的试点，并将选择额外的 通过严格的同行评审程序，在第2-5年开展试点项目。我们建议的第一年项目是： 项目1：在寿命结束时推迟机构：信息和预先指令的作用。这个项目 侧重于与医疗保健和生命末期决策有关的政策，这是一个广泛相关的主题， 人口老龄化。 项目2：阿片类药物耐受患者的急性疼痛后管理：一项随机对照试验。这 一个项目旨在提供严格的证据，说明如何有效地管理已经接受治疗的患者的疼痛。 高剂量的阿片类药物，因此有可能产生一系列负面结果，包括过量服用。 其中每个项目都将得到㈠管理和行政核心的支助， 对中心的全面领导和协调;（二）试点核心。试点核心将支持项目 发展活动，以确定有前途的第一阶段研究项目，协调选择最 有前途的试点项目的资金，支持资助试点，并建立一个持续的行为干预发展 改善老年人健康状况的计划。

ABSTRACT There is no shortage of innovative ideas for behavioral interventions to improve health care delivery in the United States. Health care delivery reform has the potential to dramatically improve the health and health care experience. This is especially true for the aging population who interact with the health care system more frequently and suffer some of the gravest health problems. However, too little is known about which interventions could be effective for improving the health of these individuals. This proposal seeks to identify, fund, and support low-cost, high-impact Stage I trials of behavioral interventions for mid-life and older people. The Abdul Latif Jameel Poverty Action Lab (J-PAL), founded in 2003, is a network of more than 165 affiliated professors at over 55 universities, united by their use of randomized evaluations to answer critical policy questions. J-PAL North America (NA) was launched at the Massachusetts Institute of Technology (MIT) in 2013 by Amy Finkelstein (MIT) and Lawrence Katz (Harvard) to apply the J-PAL approach to the region. J-PAL NA’s Health Care Delivery Initiative (HCDI) focuses on catalyzing high-quality randomized controlled trials (RCTs) to test how best to improve health care delivery. We propose to leverage this foundation to spur and support early-stage RCTs to test behavioral interventions to improve health care delivery and health outcomes for older adults. The MIT Roybal Center will support two Stage I pilots in its first year, and will select additional pilot projects in Years 2-5 through a rigorous peer review process. Our proposed Year 1 projects are: Project 1: Deferring Agency at End-of-Life: The Role of Information and Advance Directives. This project focuses on policies related to medical care and decision-making at end-of-life, a topic that is broadly relevant to the aging population. Project 2: Post-Acute Pain Management for Opioid-Tolerant Patients: A Randomized Controlled Trial. This project seeks to provide rigorous evidence on how to effectively manage pain in patients who are already on high doses of opioids and thus at risk of a host of negative outcomes, including overdose. Each of these projects will be supported by (i) the Management and Administrative Core, which will provide overall leadership and coordination for the Center and (ii) the Pilot Core. The Pilot Core will support project development activities to identify promising Stage I research projects, coordinate selection of the most promising pilots for funding, support funded pilots, and create a sustained behavioral intervention development program to improve health outcomes for older adults.