Vanderbilt Center for Education/Research on Therapeutics

描述(由申请人提供)：范德比尔特治疗学教育和研究中心(CERT)是系统改进治疗学的国家合作的一部分。我们的主题是在医疗补助和退伍军人健康管理局人群中促进最佳药物治疗。这些人群是我们关注的重点，因为他们容易受到次优疗法的伤害，人口比例过高和高成本疾病是AHRQ和其他利益相关者联邦机构的优先事项，以及自动化数据库的可用性。CERT重点关注的弱势群体包括发育中的胎儿、幼儿、低收入母亲、非裔美国人和其他少数群体、有精神和躯体残疾的人、慢性病患者、老年人和养老院的人。在这些人群中，我们将与我们的合作伙伴开展多学科研究和教育计划，以： 1.通过精心挑选的药物效应研究，填补知识库中的关键空白； 2.通过确定不太理想的做法和开展教育计划来优化治疗； 3.评估可能适得其反的政策。 我们的副主题是减少与药物相关的胃病的发生，这是一种重要的疾病，是AHRQ和其他联邦机构的优先事项，我们在这方面有丰富的经验。拟议的新的CERT继续现有的多学科CERT的工作，该组织迄今已完成63个项目并发表了50篇出版物，其中7篇发表在《新英格兰医学杂志》上，3篇发表在《柳叶刀》上，2篇发表在《美国医学会杂志》上。它与田纳西州医疗补助、州卫生部、退伍军人管理局田纳西谷医疗保健系统和老年研究、教育和临床中心、食品和药物管理局以及美国国立卫生研究院建立了牢固的合作伙伴关系。我们提出了8个新项目。4)药物效应--1)SSRIs和出生缺陷，2)ADHD药物和 3)不良心血管事件，3)药物和猝死，4)华法林和抗菌药物的相互作用；3)教育项目-5)改善治疗方法的使用，以预防患有镰状细胞疾病的儿童的中风/败血症，6)改善高危VA非类固醇抗炎药使用者的胃部保护，7)改善高危Medicaid非类固醇抗炎药物使用者的胃部保护，以及一项政策评估-8)严重精神疾病患者取消医疗补助的效果。这些项目与我们的主题/子主题紧密相关，有可能实质性地改善高度脆弱人群的临床实践，而这些人群在其他研究项目中往往代表不足。

DESCRIPTION (Provided by the Applicant): The Vanderbilt Center for Education and Research on Therapeutics (CERT) is proposed as part of a national collaboration to systematically improve therapeutics. Our theme is Promoting Optimal Pharmacotherapy in Medicaid and Veterans' Health Administration Populations. These populations are our focus because of vulnerability to suboptimal therapeutics, over-representation of populations and high cost diseases that are priorities for AHRQ and other stakeholder federal agencies, and availability of automated databases. Vulnerable groups encompassed by the CERT focus include the developing fetus, young children, low-income mothers, African-Americans and other minorities, persons with mental and somatic disabilities, the chronically ill, the elderly, and persons in nursing homes. Within these populations, we will conduct multi-disciplinary research and education programs with our partners that will: 1. Fill critical gaps in the knowledge base through carefully selected studies of drug effects; 2. Optimize therapy by identifying suboptimal practices and conducting educational programs; 3. Evaluate potentially counterproductive policies. Our sub-theme is Reducing the Occurrence of Medication-Related Gastropathy, an important disease that is a priority for AHRQ and other federal agencies and with which we have substantial prior experience. The proposed new CERTs continues the work of an existing multi-disciplinary CERTs that has completed 63 projects and generated 50 publications to date, including 7 in The New England Journal of Medicine, 3 in Lancet, and 2 in JAMA. It has established strong partnerships with Tennessee Medicaid, the State Department of Health, the VA Tennessee Valley Healthcare System and Geriatric Research, Education and Clinical Center, the Food and Drug Administration, and the NIH. We propose 8 new projects. Four are of drug effects--1) SSRIs and birth defects, 2) ADHD drugs and adverse cardiovascular events, 3) Medications and sudden death, 4) Warfarin and antimicrobial interactions; three are educational programs-5) Improving use of therapy to prevent stroke/sepsis in children with sickle cell disease, 6) Improving gastroprotection in high-risk VA NSAID users; 7) Improving gastroprotection in high-risk Medicaid NSAID users; and one is a policy evaluation-8) Effect of Medicaid disenrollment for patients with serious mental illness. These projects are tightly linked to our theme/sub-theme and have the potential to materially improve clinical practice in highly vulnerable populations that often are under-represented in other research programs.