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

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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.