Personalized Decision Making for Oral Anticoagulant Choice in Atrial Fibrillation

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ABSTRACT Junya Zhu, PhD is an Assistant Professor of Health Policy and Management and a core member in the Center for Health Services and Outcomes Research (CHSOR) at the Johns Hopkins Bloomberg School of Public Health (JHBSPH). Her long-term career goal is to become an independent investigator focusing on developing, implementing, and disseminating effective decision support interventions that improve health care quality and patient-centered outcomes. Dr. Zhu has a strong background in health services research with doctoral-level training in research methods, econometrics, survey research, and health policy. The proposed project focuses on personalized decision making for oral anticoagulant choice in atrial fibrillation (AF). Specific aims are: Aim 1: Examine whether oral anticoagulant choice among AF patients varies by prescriber specialty and prescription drug coverage. Two-level regression models will be used to analyze claims data and to address the clustering effect of patients within a physician. Aim 2: Elicit preferences for multiple attributes of the oral anticoagulants among AF patients and their physicians. We will use qualitative methods to define the attributes important to treatment decisions, elicit preferences for these attributes, and assess perceived barriers to ranking the relative importance of these attributes. Aim 3: Build on the existing literature and knowledge generated in Aim 2 to create and pilot test a personalized decision support tool for AF patients considering anticoagulant therapy. We will examine whether the use of the tool will improve patients' knowledge about AF and treatments, increase physician understanding of patient preferences and support patient decision making. These aims address AHRQ's priority of improving outcomes through the use of patient-centered outcomes research (PCOR), with a focus on improving cardiovascular health. In addition, this project will serve as a training opportunity so that Dr. Zhu can gain new knowledge of pharmacoepidemiology and cardiovascular health, and develop new skills in patient preference elicitation, decision analysis, clinical trials and intervention research. She will obtain new knowledge and skills from the training portion of the award through coursework, mentored research, and participation in relevant conferences and seminars. Dr. Zhu has assembled a multidisciplinary mentorship and advisory team of established researchers who are strongly committed to her career development and will provide the expertise required to complete this proposal. The team will be directed by Albert Wu, MD, MPH, an international expert in quality of care and PCOR. The institutional environment for the project includes several institutes and centers at the JHBSPH and School of Medicine, including CHSOR, the Center for Drug Safety and Effectiveness, and the Heart and Vascular Institute. All have tremendous resources to facilitate health services research and long histories in the successful mentorship of junior investigators. The knowledge, skills, and experience Dr. Zhu will gain from this proposed award will prepare her to successfully compete for an R01 grant, or equivalent, examining the efficacy of the tool and its potential for dissemination.