Mid-Career Mentoring Award For Patient-Oriented Research in Frailty and Health Outcomes

项目总结 越来越多的证据表明，虚弱--一种以生理功能减退为特征的老年常见问题 储备和对急性应激源的耐受能力--可能决定药物治疗后结果的个体间差异 老年人的治疗和外科手术。虽然这种理解支持个性化的想法 根据患者的脆弱程度进行治疗，很少有经验证据表明如何利用脆弱信息来 最大限度地提高老年患者的福利或避免伤害。迫切需要了解脆弱是如何影响 各种内科和外科治疗的结果。候选人是老年病学家和流行病学家。 世卫组织建立了一项强有力的以病人为导向的关于虚弱、老年药物流行病学的研究计划，以及 希伯来老年生活马库斯老龄研究所手术后功能结果的预测。他是 也是实习生和初级教员的专职导师，他们发表了许多同行评议的论文 并成功角逐老龄化研究领域的培训和职业发展奖。候选人的 研究计划有一个长期目标，即通过产生高质量的 证据，培训未来的临床医生和研究人员，以及改变卫生系统和政策。为了实现这个目标， 他目前由NIA资助的研究重点是使用医疗保险数据的脆弱性指数来确定谁应该 接受药物治疗或手术治疗的人，不应因缺乏益处或增加而接受治疗 伤害的可能性。这份K24职业中期调查员奖提案将允许候选人制定正式的 导师计划，扩大他的研究，并成为一个更有效的导师和领导者。具体目标 是：1)为来自不同领域的早期和新的研究人员制定脆弱研究的指导计划 临床和研究背景；2)进行高质量的研究以确定治疗的异质性 脆弱对广泛的医疗和外科干预措施的影响；以及3)获得新的研究技能 实施科学，加强老年医学内外的指导和领导能力。这个 希伯来老年生活和其他哈佛附属机构的出色协作环境将提供 资源(例如，各种数据源，包括医疗保险数据、计算环境和职业发展 培训课程)和支持(例如，数据科学家和研究方法专家) 建议的活动。候选人的指导和研究计划的进展，由 这一K24奖项将促进受过良好培训的临床医生研究人员在老龄化研究中的发展，并加快采用 根据患者的虚弱程度，跨内外科专科为老年人提供个性化药物。

PROJECT SUMMARY Increasing evidence suggests that frailty—a common problem of old age characterized by reduced physiologic reserve and inability to tolerate acute stressors—may determine inter-individual variability in outcomes after drug therapy and surgical procedures among older adults. While this understanding supports the idea of personalizing treatments based on a patient's frailty level, there is little empirical evidence on how to use frailty information to maximize benefits or avoid harms in older patients. There is a pressing need to understand how frailty affects the outcomes of various medical and surgical treatments. The candidate is a geriatrician and epidemiologist who has established a robust patient-oriented research program on frailty, geriatric pharmacoepidemiology, and prediction of functional outcomes after surgery at Hebrew SeniorLife Marcus Institute for Aging Research. He is also a dedicated mentor of trainees and junior faculty, who have published a number of peer-reviewed papers and have successfully competed for training and career development awards in aging research. The candidate's research program has a long-term objective to improve care of older adults with frailty by generating high-quality evidence, training future clinicians and researchers, and changing health systems and policy. Toward this goal, his current NIA-funded research focuses on use of a frailty index for Medicare data to determine who should be treated with a drug therapy or a surgical procedure and who should not due to lack of benefit or increased likelihood of harm. This K24 Mid-career Investigator Award proposal will allow the candidate to develop a formal mentoring program, expand his research, and become a more effective mentor and leader. The specific aims are to: 1) develop a mentoring program in frailty research for early-stage and new investigators from diverse clinical and research backgrounds; 2) conduct high-quality research to determine heterogeneity of treatment effects by frailty for a broad range of medical and surgical interventions; and 3) acquire new research skills in implementation science and enhance capacity in mentorship and leadership within and outside geriatrics. The outstanding collaborative environment of Hebrew SeniorLife and other Harvard-affiliated institutions will provide resources (e.g., various data sources, including Medicare data, computing environment, and career development training courses) and support (e.g., data scientists and research methodology experts) needed to accomplish the proposed activities. The advancement of the candidate's mentoring and research program, supported by this K24 award, will foster growth of well-trained clinician investigators in aging research and accelerate adoption of personalized medicine for older adults across medical and surgical specialties based on a patient's frailty level.