Research and Mentorship in Medical Decision Making for Chronic Diseases of Older Adults

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PROJECT ABSTRACT: Medical decisions for many chronic diseases such as diabetes are becoming more complex as the number of available therapies expand and as we learn how risk factor targets and treatments may need to be individualized based on a patient's clinical characteristics, genetic profiles, treatment preferences, and social circumstances. To strengthen training and research in medical decision making in the study of chronic diseases of older adults, Dr. Elbert Huang, Professor of Medicine at the University of Chicago, is submitting this K24 renewal proposal. The University of Chicago is an ideal environment for this program because of its well-established clinical research programs, history of interdisciplinary collaboration, and significant strengths in the social sciences. The overall goal of the program is to support young investigators who are studying medical decision making in older adults living with individual or multiple chronic diseases. Trainees of the program will have access to cohort studies of older adults (Kaiser Permanente Northern California Diabetes Registry, the National Social Life Health and Aging Project, national Medicaid and Medicare Claims), support for the construction and evaluation of simulation models of chronic diseases, guidance for developing decision support interventions, and facilitated access to the UChicago Practice-Based Research Network. In his own research in geriatric diabetes, Dr. Huang will pursue the following aims: 1) advance the study of variation in diabetes onset, complications and treatment response in observational studies; 2) advance the development of simulation models of diabetes complications; and 3) advance the development of diabetes decision support for personalizing care for older adults. In two ongoing observational studies (R01 AG060756, R01 AG063391), Dr. Huang will explore population-level variation in the onset of diabetes and its complications as well as variation in response to achieved glucose targets and treatments. As part of Aim 2, Dr. Huang is part of an investigative team led by his mentee, Dr. Neda Laiteerapong (R01 MD013420) developing a new simulation model of diabetes complications using multi-ethnic data from the Kaiser Registry. This model will be comprised of a series of individual outcome prediction models (cardiovascular events, hypoglycemia, dementia, mortality) that interwoven together. Under Aim 3, Dr. Huang will first complete evaluation of a trial of a decision support tool (My Diabetes GOAL) created during his initial K24. The tool, embedded within the electronic medical record, is designed to engage patients in personalized goal setting and disease management with the support of a nurse. He will also develop an updated stakeholder-informed diabetes decision support intervention for personalized care for older adults, addressing both goal setting and treatment selection. This K24 award will allow Dr. Huang to strengthen his mentorship program in medical decision making in chronic diseases and expand his research portfolio in new directions that will guide individualization of care for diverse populations of patients living with diabetes.