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

项目摘要：糖尿病等许多慢性疾病的医疗决策越来越多 随着可用疗法的数量增加，以及我们了解风险因素的靶点和治疗方法 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 老年人慢性病研究，芝加哥大学医学教授Elbert Huang博士， 正在提交此K24续订建议书。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，以及 社会科学方面的显著优势。该计划的总体目标是支持年轻的调查人员 他们正在研究患有单个或多种慢性病的老年人的医疗决策。 该计划的受训人员将有权获得老年人的队列研究(Kaiser Permanente Northern 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)，支持构建和评估慢性病模拟模型， 为制定决策支持干预措施提供指导，并促进获得以芝加哥实践为基础的美国大学 研究网络。在自己的老年糖尿病研究中，黄博士将追求以下目标：1) 糖尿病发病、并发症和治疗反应变化的观察性研究进展 研究；2)推进糖尿病并发症模拟模型的开发；3)促进 开发糖尿病决策支持，为老年人提供个性化护理。在两个正在进行的观察中 研究(R01 AG060756，R01 AG063391)，黄博士将探索人群水平的变异在发病 糖尿病及其并发症以及对达到血糖目标和治疗的反应的变化。AS 作为AIM 2的一部分，黄博士是由他的导师Neda Laiteerapong博士(R01)领导的调查小组的成员 MD013420)开发了一种新的糖尿病并发症模拟模型，该模型使用来自 凯撒注册处。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、痴呆症、死亡率)相互交织在一起。在目标3下，黄博士 将首先完成对他最初创建的决策支持工具(我的糖尿病目标)的试验的评估 K24。该工具嵌入到电子病历中，旨在让患者参与个性化的 在护士的支持下制定目标和疾病管理。他还将开发一种更新的 利益相关者知情的糖尿病决策支持干预，为老年人提供个性化护理，解决 目标设定和治疗选择。这一K24奖项将使黄博士加强他的指导 在慢性病的医疗决策方面的计划，并在新的方向扩展他的研究组合 这将指导对不同人群的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.