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最佳的治疗方案来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因素对使用不足的作用 口服抗凝剂治疗房颤拟议的培训和研究计划将使我在一个强大的 我的位置是成为一名独立的调查员，并建立我的研究小组在交叉点， 心血管药物治疗、药物流行病学和卫生服务研究。 候选人：我在药学和卫生服务研究方面的背景使我能够领导16个第一作者 同行评审的手稿然而，我缺乏先进的方法学技能来评估病人 和系统水平因素影响口服抗凝剂的使用。K 01奖项中提出的培训将建立在 我对我的背景，并提供我的技能，我目前缺乏进行拟议的研究。 培训计划：该计划包括正式的课程、讲习班、研讨会和个人指导。我会 在我的主要负责人的监督下，我将75%的精力投入到拟议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，威廉施兰克博士和约书亚索普博士将 我的共同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 实施先进的方法，包括基于组的轨迹建模，因果调解分析， 2）学习空间数据分析和可视化在卫生服务研究中的应用; 3)深入了解药房福利管理和供应商支付设计 模型，并了解如何将医疗服务研究成果转化为创新的保险，健康 服务交付，以及现实世界环境中的提供者支付模式;以及4）为了改善我的赠款写作 并提交R 01补助金申请。 研究计划：本K 01研究项目的首要主题是改善心房肌电生理学的临床结局。 房颤患者通过最佳口服抗凝治疗。我的具体目标是：1）描述轨迹 首次房颤诊断后12个月内口服抗凝药物的使用情况，并检测患者是否 特征和区域影响轨迹; 2）量化在多大程度上的地理变化， 房颤患者中缺血性卒中的发病率可归因于口腔 抗凝治疗的启动和依从性;以及3）评估保险范围和保险公司类型的影响- 提供者支付模式的使用和坚持口服抗凝治疗。 影响：这项研究的结果将指导决策者设计和实施 旨在缓解口服抗凝剂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.