Patient and System-Level Determinants of Oral Anticoagulation Use in Atrial Fibrillation

项目摘要 我的长期职业目标是通过优化改善心血管疾病患者的预后 药物使用。我的短期目标是解决患者和系统层面的因素对使用不足的影响 口服抗凝在房颤治疗中的作用。拟议的培训和研究计划将使我处于一个强大的 我的职位是成为一名独立调查员，并在 心血管药物治疗、药物流行病学和卫生服务研究。 候选人：我在药剂学和卫生服务研究方面的背景使我能够领导第一作者 同行评议的手稿。然而，我缺乏必要的高级方法技能来评估患者的耐心程度 系统层面的因素影响口服抗凝药物的使用。本K01奖项中建议的培训将建立在 我对我的背景了解很多，并为我提供了我目前缺乏的技能来进行拟议的研究。 培训计划：该计划包括正式课程、研讨会、研讨会和个人指导。这就做 在我的校长的监督下，将75%的精力投入到计划中的培训和研究活动中 导师瓦利德·盖拉德博士。玛丽亚·布鲁克斯博士、萨米尔·萨巴博士、威廉·斯林克博士和约书亚·索普博士将成为 我的联合导师和阿什利·纳伊米博士将担任顾问。我的具体培训目标是：1)学习和 实施高级方法，包括基于组的轨迹建模、因果调解分析和 2)学习空间数据分析和可视化在卫生服务研究中的使用； 3)深入了解药房福利管理和提供者付款设计 模型，并了解卫生服务研究成果如何转化为创新的保险、健康 真实环境中的服务交付和提供商支付模式；以及4)改进我的赠款撰写 技能，并提交R01拨款申请。 研究计划：K01研究计划的首要主题是改善心房的临床结果 纤颤患者通过最佳的口服抗凝治疗。我的具体目标是：1)描述轨迹 首次诊断房颤后12个月内口服抗凝使用情况并检测患者是否 特征和区域影响轨迹；2)量化地理变化在多大程度上 心房颤动患者中缺血性卒中的发生率可归因于口腔地理差异 抗凝启动和坚持；以及3)评估保险类型和保险公司的效果- 提供者对口服抗凝治疗的使用和坚持的付费模式。 影响：本研究的结果将指导政策制定者设计和实施 旨在减轻口服抗凝药物使用不足的干预措施。

Project Summary My long-term career goal is to improve outcomes of patients with cardiovascular diseases through optimal medication use. My short-term goal is to address the role of patient and system-level factors on the underuse of oral anticoagulation in atrial fibrillation. The proposed training and research program will put me in a strong positon to become an independent investigator and establish my research group at the intersection of cardiovascular pharmacotherapy, pharmacoepidemiology, and health services research. Candidate: My background in pharmacy and health services research has enabled me to lead 16 first-author peer-reviewed manuscripts. However, I lack advanced methodological skills necessary to evaluate how patient and system-level factors affect oral anticoagulation use. The training proposed in this K01 award will build on my on my background and provide me with the skills I currently lack to conduct the proposed research. Training Plan: This plan includes formal coursework, workshops, seminars and personal mentoring. I will dedicate 75% effort to the training and research activities proposed, under the supervision of my primary mentor Dr. Walid Gellad. Dr. Maria Brooks, Dr. Samir Saba, Dr. William Shrank, and Dr. Joshua Thorpe will be my co-mentors, and Dr. Ashley Naimi will serve as advisor. My specific training goals are: 1) To learn and implement advanced methods, including group-based trajectory modeling, causal mediation analysis, and hierarchical models; 2) To learn the use of spatial data analysis and visualization in health services research; 3) To develop an in-depth understanding of pharmacy benefits management and design of provider payment models, and learn how health services research findings are translated into innovative insurance, health services delivery, and provider payment models in the real-world setting; and 4) To improve my grant writing skills and submit an R01 grant application. Research plan: The overarching theme of this K01 research program is to improve clinical outcomes of atrial fibrillation patients through optimal oral anticoagulation use. My specific aims are to: 1) Describe trajectories of oral anticoagulation use in the 12 months after first atrial fibrillation diagnosis and test whether patient characteristics and region affect trajectories; 2) Quantify to what extent the geographic variation in the incidence of ischemic stroke among atrial fibrillation patients is attributable to the geographic variation in oral anticoagulation initiation and adherence; and 3) Evaluate the effect of type of insurance coverage and insurer- provider payment models on the use and adherence to oral anticoagulation therapy. Impact: The results from this research will guide policymakers on the design and implementation of interventions targeted at mitigating oral anticoagulation underuse.