The Roybal Center for TherapeuticOptimization using BehavioralScience

1循证使用处方药导致了健康老龄化的实质性改善。 2尽管如此，患者和提供者对药物的使用仍然不是最理想的。许多患者并不是 3处方指南推荐的治疗方法，他们将从中受益； 4开始适当的治疗，几乎一半不能长期坚持；其他人可能-- 5种风险和收益不平衡的危险药物。结果是：可预防的不良反应 6中老年人的健康结果和健康支出。 虽然许多因素影响处方药的次优使用，但个人、人际和 8制度行为是核心。因此，现有的解决这些问题的干预措施试图 9提醒、奖励、激励、简化或以其他方式改变行为。不幸的是，这些干预措施只有 10是适度有效的，即使在那些有效的情况下，行为改变也很少持续 11长期。结果可以解释为在设计时缺乏整合的行为原则 12项干预措施，有限地侧重于评估如何长期实施这些措施，以及固有的挑战 13在人口规模上提供精确和个性化的行为改变。 14因此，布里格姆和妇女医院罗伊巴尔治疗优化中心使用行为 15《科学》将侧重于可持续行为改变的主题领域，具体目标如下：(1) 16创建翻译研究计划，以开发原则驱动的、有效的、实用的、可扩展的和 17可持续的行为干预措施，以加强循证的适当处方和使用 18种药物；(2)战略指导和提供科学监督、项目管理、财政和 19提供业务支持，以确保成功完成中心通过 20行政核心；以及(3)进行严格的试点研究，评估以原则为导向的干预措施 21通过试点核心维持使用循证药物的行为改变。 22第一年的拟议试点将是第I阶段的研究，包括第0阶段的组成部分、评估原则- 23驱动型干预，通过强化学习和重复提示奖励优化信息框架， 24.改善用药不依从性。在接下来的几年中，试点将专门征集符合以下条件的申请 25解决其他行为(即开药不足和过量)，以及影响健康的更广泛的健康状况 26健康老龄化，包括认知障碍，可在其他练习环境和分娩中进行 27个系统，包括与健康保险公司和大雇主的合作。 28使用行为科学的罗伊巴尔治疗优化中心的预期影响是 29将制定以原则为导向的干预措施，很容易转化为健康老龄化的改善，并将 30还促进了我们对如何有效地维持健康行为的基本理解。

1 The evidence-based use of prescription medications has led to substantial improvement in healthy aging. 2 Despite this, the use of medications by patients and providers remains suboptimal. Many patients are not 3 prescribed guideline-recommended therapies from which they would benefit; among those for whom 4 appropriate treatment is initiated, almost half do not adhere over the long-term; and, others receive potentially- 5 hazardous medications with an unfavorable balance of risks and benefits. The result: preventable adverse 6 health outcomes and health spending for middle-aged and older adults. 7 While many factors influence the suboptimal use of prescription medications, individual, interpersonal and 8 institutional behaviors are central. As a result, existing intervention to address these issues have attempted to 9 remind, reward, motivate, simplify or otherwise change behavior. Unfortunately, these interventions have only 10 been modestly effective and even among those that are effective, behavior change is rarely sustained over the 11 long-term. The results can be explained by the lack of integrating behavioral principles when designing 12 interventions, a limited focus on evaluating how to deliver them over the long term, and the inherent challenges 13 in delivering precise and personalized behavior change at population scale. 14 Thus, the Brigham and Women's Hospital Roybal Center for Therapeutic Optimization using Behavioral 15 Science will focus on the thematic area of sustaining behavior change, with the following specific aims: (1) to 16 create a translational research program for the development of principle-driven, potent, practical, scalable and 17 sustainable behavioral interventions to enhance the appropriate prescribing and use of evidence-based 18 medications; (2) to strategically direct and to provide scientific oversight, project management, fiscal and 19 operational support to ensure the successful completion of pilot projects funded by the Center through the 20 Administrative Core; and (3) to conduct rigorous pilot studies evaluating principle-driven interventions that aim 21 to sustain behavior change for the use of evidence-based medications through the Pilot Core. 22 The proposed pilots for Year 1 will be Stage I studies, with Stage 0 components, evaluating principle- 23 driven interventions, optimizing message framing through reinforcement learning and repetition-cue-rewards, 24 to improve medication non-adherence. Pilots in subsequent years will specifically solicit applications that 25 address other behaviors (i.e. under and over-prescribing), a broader range of health conditions that impact 26 healthy aging, including cognitive impairment, and that can be conducted in other practice settings and delivery 27 systems, including with health insurers and large employers. 28 The expected impact of the Roybal Center for Therapeutic Optimization using Behavioral Science is that it 29 will develop principle-driven interventions that will readily translate to improvements in healthy aging and will 30 also advance our fundamental understanding of how health behaviors can be effectively sustained.