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

项目摘要：针对糖尿病等慢性疾病的医疗决策越来越多， 随着可用疗法数量的增加，以及我们了解风险因素靶点和治疗方法， 可能需要根据患者的临床特征、遗传特征、治疗 偏好和社会环境。加强医疗决策的培训和研究， 老年人慢性病的研究，芝加哥大学医学教授埃尔伯特黄博士， 正在提交K24更新提案芝加哥大学是这个项目的理想环境 由于其完善的临床研究计划，跨学科合作的历史， 在社会科学方面的优势。该计划的总体目标是支持年轻的研究人员 他们正在研究患有个体或多种慢性疾病的老年人的医疗决策。 该计划的学员将有机会获得老年人的队列研究（凯撒永久北方 加州糖尿病登记处，国家社会生活健康和老龄化项目，国家医疗补助和 医疗保险索赔），支持慢性病模拟模型的构建和评估， 制定决策支持干预措施的指导，并促进了对芝加哥大学基于实践的 中国互联网.在他自己的老年糖尿病研究中，黄博士将追求以下目标： 在观察中推进糖尿病发病、并发症和治疗反应变化的研究 研究; 2）推进糖尿病并发症模拟模型的开发; 3）推进 发展糖尿病决策支持，为老年人提供个性化护理。在两个正在进行的观察 研究（R 01 AG 060756，R 01 AG 063391），黄博士将探索发病的人群水平变化， 糖尿病及其并发症，以及对已达到的葡萄糖目标和治疗的响应变化。作为 作为目标2的一部分，黄博士是由他的学员Neda Laiteerapong博士（R 01）领导的调查小组的一员 MD 013420）使用来自 凯撒登记处。该模型将由一系列单独的结果预测模型组成 （心血管事件，低血糖，痴呆，死亡率）交织在一起。在目标3下，黄博士 我将首先完成一个试验的决策支持工具（我的糖尿病目标）的评估，在他最初的 K24该工具嵌入在电子病历中，旨在让患者参与个性化的 在护士的支持下制定目标和进行疾病管理。他还将开发一个更新的 老年人个性化护理的知情糖尿病决策支持干预， 目标设定和治疗选择。这个K24奖项将使黄博士能够加强他的指导 计划在慢性病的医疗决策，并扩大他的研究组合在新的方向 这将指导不同人群糖尿病患者的个性化护理。

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.