Testing the Effectiveness of Individualized Disease Prevention for Middle-Aged Adults

检验中年个体化疾病预防的有效性

• 批准号: 10398138
• 负责人: Glen Taksler
• 金额: $ 58.36万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10398138
• 关键词: Adherence; Adult; Advisory Committees; Age; Age Factors; Arthritis; Asthma; Behavior; Benefits and Risks; Characteristics; Chronic Disease; Clinic; Clinical; Clinical Research; Colonoscopy; Decision Aid; Electronic Health Record; Ensure; Foundations; Goals; Guidelines; Health; Immunization; Individual; Information Technology; Intervention; Life; Life Expectancy; Life Style; Mammography; Measures; Medical History; Medicine; Methods; Modeling; Patient Preferences; Patients; Persons; Physicians; Prevention; Prevention Guidelines; Preventive care; Preventive service; Primary Health Care; Process; Provider; Publishing; Quality of life; Quality-Adjusted Life Years; Race; Recommendation; Risk Factors; Savings; Screening for cancer; Services; Standardization; Testing; Time; United States; Visit; Weight; aged; aging population; base; blood pressure reduction; care delivery; care systems; comorbidity; cost; diabetic; disorder prevention; effectiveness testing; evidence base; health care service; hypertensive; individualized medicine; mathematical model; middle age; prevent; randomized trial; sex; shared decision making; side effect; smoking cessation; successful intervention; tool

Project Summary/Abstract This proposal seeks to help middle-aged adults (aged 50-64 y) make an informed decision about the health care services that are most likely to promote a longer, healthier life. There are currently 26 evidence-based services to prevent or manage chronic disease in middle-age, but it is difficult to follow them all. Patients need help to better understand the tradeoffs between services. To overcome these barriers, we are currently conducting an R21 that identifies the preventive services with the greatest impact on life expectancy, and engages patients and providers in shared decision-making. Patients and providers highly value the framework. We also are developing proof-of-concept to access and print the results in the electronic health record. This proposal has 3 aims. First, we will adapt a previously-published analytic model to measure the gain in quality-adjusted life expectancy associated with adherence to 24 of 26 major preventive care services. Results will be individualized for a patient’s age and risk factors. Second, we will integrate a previously-developed decision aid with the electronic health record. We will conduct iterative testing to ensure accuracy and usefulness. Third, we will conduct a randomized trial to test the effectiveness of the decision aid on middle- aged patient behavior in diverse primary care clinics. During clinical visits, patients and physicians will discuss the decision aid and engage in shared decision making, to prioritize preventive care goals. We will measure the change in preventive care utilization between intervention and control patients. This proposal builds upon our inter-disciplinary team’s strong foundation in clinical research, mathematical modeling, shared decision-making and information technology. A successful intervention should help to fundamentally change preventive care delivery in the United States, to maximize health and prevent illness in the middle-aged population.

项目概要/摘要 该提案旨在帮助中年人（50-64 岁）就健康做出明智的决定 最有可能促进更长寿、更健康生活的护理服务。目前有 26 个基于证据的 预防或管理中年慢性疾病的服务，但很难全部遵循。患者需要 有助于更好地理解服务之间的权衡。 为了克服这些障碍，我们目前正在开展 R21，将预防性服务与 对预期寿命影响最大，并使患者和提供者参与共同决策。患者 提供商高度重视该框架。我们还正在开发概念验证来访问和打印 电子健康记录中的结果。 该提案有 3 个目标。首先，我们将采用之前发布的分析模型来衡量增益 质量调整预期寿命与遵守 26 项主要预防保健服务中的 24 项相关。结果 将根据患者的年龄和风险因素进行个体化。其次，我们将整合之前开发的 电子健康记录的决策辅助。我们将进行迭代测试以确保准确性和 用处。第三，我们将进行一项随机试验来测试决策援助对中产阶级的有效性。 不同初级保健诊所中老年患者的行为。在临床访问期间，患者和医生将讨论 决策援助并参与共同决策，以优先考虑预防性护理目标。我们将测量 干预患者和对照患者之间预防性护理利用的变化。 该提案建立在我们的跨学科团队在临床研究、数学 建模、共享决策和信息技术。成功的干预应该有助于 从根本上改变美国的预防保健服务，最大限度地提高人们的健康水平并预防疾病 中年人口。