Midcareer Mentoring Award for Patient-Oriented Research in Aging

描述（由申请人提供）：随着美国人口的老龄化，为了优化老年人的成本-质量权衡，已经投入了巨大的努力来改革卫生保健服务，包括发布卫生保健提供者的高质量信息，改变支付系统以奖励护理的质量和价值，并将初级保健服务转变为以患者为中心的高价值护理。然而，对于这些改革是否达到了改善美国老年人护理的目标，以及如果没有达到，如何改善这些目标，人们所知相对较少。我目前的研究创新性地利用国家数据集，对这些政策对老年人护理的影响进行严格评估。这些研究评估了旨在提高老年患者护理质量的质量措施和激励措施是否有效，这些措施和激励措施的哪些方面有效，哪些方面无效，以及如何改进质量措施和激励措施。这项研究为改善质量倡议提供了实践经验，为新的创新交付系统的规划和实施提供了信息，并对老年人的临床实践和政策产生了重大影响。我的目标是继续进行这项研究。展望未来，我还打算扩大我的研究计划，从检查医疗保健政策对老年人的影响，到实施和评估旨在改善老年人健康和福祉的医疗保健服务创新，并利用我的研究计划来培训和指导改善老年人医疗保健服务领域的新研究者。因此，本提案的具体目的是：1)开展高质量的研究，考察医疗保健政策和服务体系对老年慢性病和复杂疾病患者护理质量的影响，以提高质量为目标，在创新医疗保健服务干预措施的设计和测试方面提供新的方向，以改善患者护理。这一目标将通过完成目前资助的观察性研究来实现，这些研究的重点是改进养老院中质量措施和激励措施的使用，并开展新的基于干预的分娩转型研究。2)利用我的研究作为一个平台，指导新的研究者改善老年人的医疗保健服务，帮助他们成为独立的研究者，并支持训练有素的以患者为导向的老年研究人员在该领域的扩展。这一目标将通过我的学员直接参与我正在进行的和新的观察性研究和临床试验来实现，利用我的程序化研究基础设施来支持我的学员的调查，并不断招募高素质的学员加入我的研究和指导计划。我的总体目标是提高患有慢性和复杂疾病的老年人的护理质量。最终，我正在进行的和拟议中的研究，加上我在该领域培养杰出研究人员的指导计划，旨在帮助解决改革医疗保健提供系统的关键需求，从而有效地为数百万需要更好护理的美国老年人提供高质量的护理。

DESCRIPTION (provided by applicant): With the aging of the U.S. population, enormous efforts have been devoted to reforming health care delivery to optimize the cost-quality tradeoff for older adults, including publishing quality information on health care providers altering payment systems to reward the quality and value of care and transforming primary care delivery to focus on patient-centered, high-value care. Yet relatively little is known about whether these changes achieve their goal of improving care for older Americans and, if not, how to improve them so they do. My current research makes innovative use of national datasets to conduct rigorous evaluations of the impact of these policies on the care for older adults. These studies have evaluated whether or not quality measures and incentives aimed at improving quality of care for older patients work, what aspects of these measures and incentives works versus doesn't work, and how to improve quality measurement and incentives. This research has provided practical lessons on ways to improve quality improvement initiatives, has informed the planning and implementation of new innovative delivery systems, and has had a significant impact on clinical practice and policy for older adults. I aim to continue conducting this research Looking forward, I also aim to expand my research program from examining the impact of health care policies on older adults to implementing and evaluating health care delivery innovations designed to improve the health and wellbeing of older adults~ and to use my research program to train and mentor new investigators in the field of improving health care delivery for older adults. Thus, the SPECIFIC AIMS of this proposal are: 1) To conduct high-quality research examining the impact of health care policies and delivery systems on quality of care for older adults with chronic and complex illness, with the goal of improving the quality with a new direction on the design and testing of innovative health care delivery interventions to improve patient care. This aim will be accomplished through the completion of currently funded observational studies focusing on improving the use of quality measures and incentives in nursing homes and the conduct of new intervention-based studies of delivery transformation. And 2) To use my research as a platform to mentor new investigators in improving health care delivery for older adults, to help them become independent investigators and support the expansion of the field with well-trained patient-oriented researchers in aging. This aim will be accomplished through direct involvement of my trainees in my ongoing and new observational studies and clinical trials~ leveraging my programmatic research infrastructure to enable my mentees' investigations~ and ongoing recruitment of high-caliber mentees to my research and mentoring program. My overall goal is to improve the quality of care for older adults with chronic and complex diseases. Ultimately, my ongoing and proposed research, coupled with my mentorship program to train outstanding investigators in the field, is designed help address the critical need to reform the health care delivery system to efficiently bring high quality care to te millions of aging Americans in need of better care.