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METHODOLOGY FOR DEVELOPING ADAPTIVE INTERVENTIONS

制定适应性干预措施的方法

基本信息

批准号：
7679636
负责人：
SUSAN A MURPHY
金额：
$ 48.39万
依托单位：
PENNSYLVANIA STATE UNIVERSITY, THE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2010-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7679636
关键词：
Address Adherence Adverse effects Affect Appendix Behavioral Clinical Clinical Trials Collection Communication Costs and Benefits Counseling Data Data Analyses Decision Making Dependence Development Dose Drug Addiction Drug abuse Ensure Experimental Designs Facility Construction Funding Category Feedback Fostering Future Goals Greenland Health Human Individual International Intervention Literature Measures Methodology Methods Modeling Numbers Outcome Output Patient observation Patients Personal Communication Personal Satisfaction Pharmaceutical Preparations Pharmacologic Substance Prevention Prevention program Preventive Intervention Principal Investigator Prior Therapy Public Health Purpose Randomized Randomized Controlled Clinical Trials Relapse Research Research Design Research Personnel Research Project Grants Resistance Resources Risk Robin bird Scientist Severities Societies Standards of Weights and Measures Therapeutic Time Work base cost craving design drug abuse prevention experience improved indexing innovation interest preference prevent response stressor success symposium tool treatment effect

项目摘要

The long-term goal of this project is to improve clinical practice and thus public health by facilitating the evidence-based construction of efficacious, adaptive preventive interventions and treatments in drug abuse. Clinicians naturally adapt the level and type of therapy according to patient outcomes such as severity, response to past therapy, risk, stressors, adherence, preference and burden. This project will develop methods for informing and enhancing this adaptive clinical practice. Adaptive interventions are composed of operationalized decision rules that input patient outcomes and output recommended alterations in intensity and/or type of therapy. The construction of adaptive interventions requires addressing questions such as, "How do we best use measures of risk and other outcomes in order to decide when a patient's therapy needs to be intensified or stepped down?". "What sequence of therapies is best for achieving maximal improvement or preventing drug dependence?" and "Should this sequence of therapies vary by patient outcomes?" This project facilitates the construction of adaptive interventions by developing the following methodological innovations. First, practical experimental designs that will yield data most useful in constructing evidence-based adaptive interventions will be developed. Second, this project will improve and evaluate analysis methods that can be used with subject data in which either or both the timing of therapeutic changes and therapy alterations are randomized. These methods can be used to construct the decision rules that comprise an adaptive intervention. Third, this project will provide methods that can be used with subject data in which the timing of therapeutic changes and therapy alterations were made according to decision rules. This third group of methods can be used to assess the utility of the decision rules comprising an implemented adaptive intervention. To ensure applicability and receive feedback this work will include collaborative research with health scientists interested in constructing adaptive interventions. The goal is to accelerate the improvement of both prevention programs and treatments. Because drug abuse and dependence are costly to society, the broader public benefits from improved prevention programs aimed at reducing drug abuse and from improved treatment for drug dependent individuals.

该项目的长期目标是通过促进建立有效的、适应性的药物滥用预防干预和治疗，改善临床实践，从而改善公共卫生。临床医生根据患者的严重程度、对过去治疗的反应、风险、应激源、依从性、偏好和负担等自然调整治疗水平和类型。该项目将开发通知和加强这种适应性临床实践的方法。适应性干预由可操作的决策规则组成，这些规则输入患者的结果并输出建议的强度和/或治疗类型的改变。适应性干预措施的构建需要解决以下问题： “我们如何最好地使用风险和其他结果的衡量标准，以决定何时需要加强或停止患者的治疗？”“什么样的治疗顺序最能最大限度地改善病情或预防药物依赖？”以及“这一系列的治疗是否应该因患者的结果而不同？”该项目通过发展以下方法创新，促进了适应性干预措施的建设。首先，将开发实用的实验设计，这些设计将产生对构建循证适应性干预最有用的数据。其次，该项目将改进和评估可用于研究对象数据的分析方法，在这些分析方法中，治疗改变的时间或治疗改变的时间是随机的。这些方法可用于构建包含自适应干预的决策规则。第三，该项目将提供可以与根据决策规则进行治疗改变和治疗改变的时间的受试者数据一起使用。这第三组方法可用于评估包括实施的自适应干预的决策规则的实用性。为了确保适用性和获得反馈，这项工作将包括与对构建适应性干预措施感兴趣的卫生科学家进行合作研究。目标是加快预防方案和治疗方案的改进。由于药物滥用和依赖对社会来说代价高昂，更广泛的公众受益于旨在减少药物滥用的改善预防计划和改善对药物依赖者的治疗。