Optimizing the Treatment of Diabetes Patients

优化糖尿病患者的治疗

• 批准号: 7669149
• 负责人: NILAY D SHAH
• 金额: $ 13.99万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-11 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7669149
• 关键词: Optimizing; Treatment; Diabetes; Patients

DESCRIPTION (provided by applicant): Optimizing the Treatment of Diabetes Patients. Medically complex patients present an important challenge for implementing quality measurement programs and for improving the quality of care in the U.S. healthcare system. Patients with type 2 diabetes are a growing population of complex patients with complicated treatment regimens and high number of comorbid conditions. Treatment prioritization in this population is increasingly important since patients with diabetes have, on average, 3.5 comorbid conditions with hypertension and hyperlipidemia being the most common. There has been an increasing emphasis on evaluating provider performance for evidence-based diabetes care. However, these measures assume one-size fits all, and do not account for changing needs and preferences of the patients with age, disease state, and comorbidities. Thus, it is often difficult for primary care clinicians to prioritize interventions for diabetes patients that would be sensitive to patient preferences and at the same time respond to external quality measurement requirements. Over the next two years, we will bridge this gap by advancing knowledge regarding the optimal treatment of diabetes as measured by the patient's quality adjusted lifespan, adherence to treatment, the costs of treatment, and cost of diabetes-related complications to the health system. Specifically, we will focus on developing mathematical models to determine the optimal time for initiating and intensifying treatment for the management of diabetes, hypertension, and hyperlipidemia. Using longitudinal datasets, we aim to better understand the medication taking behavior in diabetes patients, most importantly the aspects related to adherence. The results of these analyses will then be incorporated into our mathematical models. Thus, our models will provide optimal timing of treatment assuming perfect adherence, but also at different levels of non-adherence. Incorporating non- adherence will provide us more realistic scenarios related to treatment and greater opportunity to influence the patient's length and quality of life. The findings from this study will then be translated to decision aids. These decision aids can be tested in practical randomized trials to evaluate the extent to which they can realize improved value of healthcare by enhancing outcomes and quality of care at an efficient cost.

描述（由申请人提供）：优化糖尿病患者的治疗。医疗复杂的病人提出了一个重要的挑战，实施质量测量计划，提高护理质量在美国的医疗保健系统。2型糖尿病患者是一个不断增长的复杂患者群体，具有复杂的治疗方案和大量的共病状况。由于糖尿病患者平均有3.5种合并症，其中高血压和高脂血症最常见，因此在这一人群中优先治疗越来越重要。有越来越多的重视评估提供者的表现，以证据为基础的糖尿病护理。然而，这些措施假设一刀切，并没有考虑到随着年龄，疾病状态和合并症的患者的需求和偏好的变化。因此，初级保健临床医生通常很难优先考虑对患者偏好敏感并同时响应外部质量测量要求的糖尿病患者干预措施。在接下来的两年里，我们将通过推进有关糖尿病最佳治疗的知识来弥合这一差距，这些知识是通过患者的质量调整寿命、治疗依从性、治疗成本和糖尿病相关并发症对卫生系统的成本来衡量的。具体而言，我们将专注于开发数学模型，以确定启动和强化治疗的最佳时间，以管理糖尿病，高血压和高脂血症。使用纵向数据集，我们的目标是更好地了解糖尿病患者的服药行为，最重要的是与依从性相关的方面。这些分析的结果将被纳入我们的数学模型。因此，我们的模型将提供最佳的治疗时机，假设完美的遵守，但也在不同程度的不遵守。消除不依从性将为我们提供与治疗相关的更现实的场景，并有更大的机会影响患者的生活长度和质量。这项研究的结果将转化为决策辅助工具。这些决策辅助工具可以在实际的随机试验中进行测试，以评估它们在多大程度上可以通过以有效的成本提高结果和护理质量来实现医疗保健的价值。

项目成果

Optimizing statin treatment decisions for diabetes patients in the presence of uncertain future adherence.

在未来依从性不确定的情况下，优化糖尿病患者的他汀类药物治疗决策。

• DOI: 10.1177/0272989x11404076
• 发表时间: 2012
• 期刊: Medical decision making : an international journal of the Society for Medical Decision Making
• 作者: Mason,JenniferE;England,DarinA;Denton,BrianT;Smith,StevenA;Kurt,Murat;Shah,NilayD
• 通讯作者: Shah,NilayD

Second-line agents for glycemic control for type 2 diabetes: are newer agents better?

2 型糖尿病血糖控制的二线药物：新药物更好吗？

• DOI: 10.2337/dc13-1901
• 发表时间: 2014
• 期刊: Diabetes care
• 影响因子: 16.2
• 作者: Zhang,Yuanhui;McCoy,RozalinaG;Mason,JenniferE;Smith,StevenA;Shah,NilayD;Denton,BrianT
• 通讯作者: Denton,BrianT

Comparative effectiveness of guidelines for the management of hyperlipidemia and hypertension for type 2 diabetes patients.

• DOI: 10.1371/journal.pone.0016170
• 发表时间: 2011-01-25
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Shah ND;Mason J;Kurt M;Denton BT;Schaefer AJ;Montori VM;Smith SA
• 通讯作者: Smith SA