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

项目摘要 越来越多的证据表明，脆弱-一个常见的问题，老年人的特点是减少生理 储备和无法忍受急性应激-可能决定个体间的差异，在药物治疗后， 治疗和外科手术在老年人。虽然这种理解支持个性化的想法， 尽管基于患者的虚弱程度进行治疗，但关于如何使用虚弱信息来 最大限度地提高老年患者的获益或避免伤害。我们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。候选人是一位老年病学家和流行病学家 世卫组织建立了一个强大的以患者为导向的研究项目，涉及虚弱、老年药物流行病学和 希伯来老年生活马库斯老龄研究所手术后的功能结果预测。他是 也是一个专门的导师的学员和初级教师，谁发表了一些同行评议的论文 并成功地竞争了老龄化研究方面的培训和职业发展奖。候选人的 一项研究计划的长期目标是通过产生高质量的 证据，培训未来的临床医生和研究人员，改变卫生系统和政策。为了实现这一目标， 他目前的研究重点是使用医疗保险数据的脆弱指数，以确定谁应该 接受药物治疗或外科手术治疗的患者，由于缺乏获益或增加 伤害的可能性。这个K24职业中期研究者奖提案将允许候选人制定一个正式的 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）制定一个指导计划，在脆弱性研究的早期阶段和新的调查人员从不同的 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 脆弱的影响，为广泛的医疗和外科干预措施;和3）获得新的研究技能， 实施科学和加强老年医学内外指导和领导能力。的 希伯来SeniorLife和其他哈佛附属机构的杰出合作环境将提供 资源（例如，各种数据源，包括Medicare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）， 拟议的活动。候选人的指导和研究计划的进步，由 这项K24奖将促进老龄化研究中训练有素的临床研究人员的成长，并加速采用 根据患者的虚弱程度，为医疗和外科专业的老年人提供个性化医疗。

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.