Determining Processes of Cardiovascular Care Relevant to Complex Patients

确定与复杂患者相关的心血管护理流程

• 批准号: 8015785
• 负责人: ELIZABETH A BAYLISS
• 金额: $ 46.24万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015785
• 关键词: Determining; Processes; Cardiovascular; Care; Relevant

DESCRIPTION (provided by applicant): Clinicians who care for persons with complex chronic medical conditions face both competing demands and a lack of evidence regarding best processes of care for this heterogeneous population. Those clinicians facing decisions about prevention of coronary heart disease (CHD) following a new diagnosis of cancer must take into account cancer prognosis, cardiovascular risk status, overall burden of morbidity, and the patient's goals, preferences and values. To help inform such decisions, we propose to use analytic epidemiology methods to study an historical cohort of all (over 30,000) Kaiser Permanente Colorado (KPCO) adult members who received an initial diagnosis of cancer during the period 1999 to 2007. In this cohort, we will a) assess the attainment of goals for specific components of primary, secondary, and 'tertiary' prevention of CHD as a function of cancer prognosis, overall morbidity and the interaction between them, and b) assess the comparative effectiveness of these CHD prevention interventions (in relevant sub-cohorts) on receipt of, and time to, a composite of CHD events and all-cause mortality. We hypothesize that: a) Overall morbidity, cancer prognosis, and the interaction between them will affect attainment of goals of preventive interventions for CHD; and b) specific strata of morbidity and cancer prognosis will modify the effectiveness of these interventions on the CHD outcomes. In evaluating these prevention strategies on CHD outcomes, we will study the processes of care for the comorbidities of hypertension, diabetes, hyperlipidemia, and pre-existing CHD. We will use linear regression models and Cox proportional hazard models to assess the impact of the cancer prognosis and other morbidity scores (and their interactions) on the CHD prevention outcomes. A Cox proportional hazards model will be used to assess the effectiveness of the prevention measures on time to the CHD composite outcome across strata defined by prognosis/morbidity. Finally, we will describe which prevention measures most influence which components of the CHD outcomes. Information from this investigation will inform recommendations for the use of these specific preventive interventions in patients with a range of morbidities in order to make these recommendations congruent with an evidence base that acknowledges complex patients' priorities, time, and resources. PUBLIC HEALTH RELEVANCE: Relevance if we find differences in the comparative effectiveness of certain components of coronary heart disease prevention interventions across different levels of morbidity, policy implications could range from informing guideline development for the care of complex patients, to changes in reimbursement strategies for clinician time involved in shared decision-making. More importantly, findings will provide complex patients and their clinicians with additional information to inform personalized decisions across a spectrum of care.

描述（由申请人提供）：临床医生谁照顾复杂的慢性医疗条件的人面临着竞争的需求和缺乏证据的最佳过程护理这一异质人群。在新诊断为癌症后，面临预防冠心病决策的临床医生必须考虑癌症预后、心血管风险状况、发病率的总体负担以及患者的目标、偏好和价值观。为了帮助做出这样的决定，我们建议使用分析流行病学方法来研究1999年至2007年期间首次诊断为癌症的所有（超过30,000）Kaiser Permanente Colorado （KPCO）成年会员的历史队列。在这个队列中，我们将a)评估作为癌症预后、总体发病率和它们之间相互作用的功能的冠心病的初级、二级和“三级”预防的特定组成部分的目标实现情况，以及b)评估这些冠心病预防干预措施（在相关的亚队列中）在收到冠心病事件和全因死亡率的复合数据时的相对有效性。我们假设：a)总体发病率、癌症预后以及两者之间的相互作用将影响冠心病预防干预目标的实现；b)发病率和癌症预后的特定层次将改变这些干预措施对冠心病结局的有效性。在评估这些预防策略对冠心病结果的影响时，我们将研究高血压、糖尿病、高脂血症和既往冠心病合并症的护理过程。我们将使用线性回归模型和Cox比例风险模型来评估癌症预后和其他发病率评分（及其相互作用）对冠心病预防结果的影响。将使用Cox比例风险模型来评估预防措施对由预后/发病率定义的分层冠心病综合结局的及时有效性。最后，我们将描述哪些预防措施对冠心病结果的哪些组成部分影响最大。这项调查的信息将为在各种发病率的患者中使用这些特定预防干预措施的建议提供信息，以便使这些建议与承认复杂患者优先事项、时间和资源的证据基础一致。

项目成果

How to design and evaluate interventions to improve outcomes for patients with multimorbidity.

如何设计和评估干预措施以改善多病患者的治疗结果。

• DOI: 10.15256/joc.2013.3.21
• 发表时间: 2013
• 期刊: Journal of comorbidity
• 作者: Smith,SusanM;Bayliss,ElizabethA;Mercer,StewartW;Gunn,Jane;Vestergaard,Mogens;Wyke,Sally;Salisbury,Chris;Fortin,Martin
• 通讯作者: Fortin,Martin