Health Services Use: Analysis of ACTIVE Data

描述（由申请人提供）：本R03的具体目的是对1998-2001年进行的独立和重要老年人高级认知训练（ACTIVE）试验的数据进行二次分析。该研究是由美国国家老龄研究所（NIA）和美国国家护理研究所（NINR）资助的一项临床试验，在一个数据协调中心的六个现场进行。ACTIVE的主要目的是测试三种不同的认知干预措施的有效性和持久性，以改善老年人在基本认知测量和认知要求日常活动测量中的表现（据JAMA， 2002年报道）。这一倡议的最终目标是减少与老年人丧失独立能力有关的公共卫生问题，特别是减少对正规保健服务的需求。本提案的主要目的是评估ACTIVE认知干预措施在减少对正规卫生保健服务的需求和使用方面的有效性。该项目的具体目的是分析数据：1)调查认知训练对参与者健康相关生活质量的影响；2)评估干预组分配与正规卫生保健服务利用的关系；3)评估近端干预效果（训练认知能力改善程度）和远端卫生服务使用结果的中介作用；4)通过比较自我报告的（医疗保险可报销）服务使用情况与医疗保险索赔数据，评估自我报告的医疗服务利用情况的有效性。ACTIVE是最大的纯行为治疗试验之一。由于它的规模和精心开发的严谨性，它的数据集为调查人员提供了大量的二次分析机会。ACTIVE试验的资金已于2002年12月31日结束。正在申请资金支持研究人员的工作，以分析由于初始奖励资金不足而未被调查的次要结果。试验数据目前正在存档，供公众使用，仅供ACTIVE研究人员使用。

DESCRIPTION (provided by applicant): The Specific Aim of this R03 is to conduct secondary analyses of data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, which was conducted from 1998-2001. The study was a clinical trial funded by the National Institute of Aging (NIA) and National Institute on Nursing Research (NINR) and conducted at six field sites with a data-coordinating center. The primary objective of ACTIVE was to test the effectiveness and durability of three distinct cognitive interventions in improving older adults' performance on basic measures of cognition and on measures of cognitively demanding daily activities (reported in JAMA, 2002). The ultimate goal of this initiative was to reduce the public health problems related to loss of independence in the elderly, specifically the need for formal health care services. The Primary Aim of this proposal is to evaluate the effectiveness of the ACTIVE cognitive interventions in reducing demand for and use of formal health care services. The Specific Aims of the proposed project are to analyze data to: 1) investigate the effect of cognitive training on participants' health-related quality of life; 2) evaluate the relationship of intervention group assignment and formal health care services utilization; 3) evaluate the mediating role of proximal intervention effectiveness (degree of improvement in trained cognitive abilities) and distal health services use outcomes; and 4) assess the validity of self-reported health services utilization by comparing self-reported use of (Medicare reimbursable) services to Medicare claims data. ACTIVE is one of the largest purely behavioral treatment trials. Because of its size and the carefully developed rigor, its datasets offer to investigators a wealth of opportunities for secondary analyses. Funding for the ACTIVE trial ended on 12/31/02. Funds are being requested to support the work of the study investigators to analyze secondary outcomes not previously investigated due to insufficiency of funds in the initial award. The trial data currently are being archived for public use and are available only to the ACTIVE investigators.