Treatment Burden in Older Adults with Diabetes and Multimorbidity

描述（由申请人提供）：美国老龄人口中慢性病的患病率不断增加，这对提供以患者为中心并符合循证指南的医疗护理提出了重大挑战。Boyd博士先前的工作表明，将疾病特异性指南应用于患有多发性硬化症的老年患者受到推荐治疗方案和监测要求的复杂性、费用和负担的限制。为我们的老龄化社会提供最佳护理需要为医学复杂的老年患者开发实用的循证治疗模式，这些模式允许根据患者偏好和感知的治疗负担灵活设定目标。因此，该项目的总体目标是开发一种实用的工具，用于评估患有多种疾病的老年患者的治疗负担，以协助医疗决策。为此，Boyd博士建议研究具有糖尿病指数诊断的老年人与其他合并症的组合，作为检查多发病治疗负担的模型。我们建议通过对指导性护理项目（一项针对患有多种疾病的老年人的研究（目标1））的数据进行二次分析，以及通过一系列焦点小组（目标2），来描述该人群中治疗负担的领域和调节因素。我们将综合这些数据和文献中的数据，以开发治疗负担的临床实用措施（目标3），最后，我们将在临床环境中对该工具进行初步测试（目标4），为R01研究做准备，以评价该工具在改善患者依从性和更广泛的多发病患者人群结局方面的临床效用。这项工作将为临床研究生涯提供基础，重点是改善老年人的决策和结果。博伊德博士的目标是成为一名独立的临床研究者，致力于改善老年人的护理与多morphine。博伊德已经制定了一个研究路径，这是她以前的工作的直接延伸，并将在一个结构化的职业发展计划，其中包括课程，指导和多学科研究咨询委员会进行。 相关性：许多老年人有多种并存的条件，但目前还不知道如何最好地同时管理这些条件。博伊德博士的目标是改善临床决策和结果的老年人与多发性硬化症。

DESCRIPTION (provided by applicant): The increasing prevalence of chronic disease in the aging U.S. population presents substantial challenges to delivering medical care that is both patient-centered and consistent with evidence-based guidelines. Dr. Boyd's prior work demonstrated that the application of disease-specific guidelines to older patients with multimorbidity is limited by the complexity, expense, and burden of the recommended therapeutic regimens and monitoring requirements. Optimal care for our aging society entails the development of practical evidence-based treatment models for medically-complex older patients that permit flexible goal-setting according to patient preferences and perceived treatment burden. The overall goal of this project is therefore to develop a practical tool for assessing treatment burden among older patients with multimorbidity, to assist in medical decision making. Toward this end, Dr. Boyd proposes to study older individuals with an index diagnosis of diabetes in combination with other comorbid conditions as a model for examining treatment burden in multimorbidity. We propose to characterize the domains and moderators of treatment burden in this population via a secondary analysis of data from the Guided Care project, a study of older adults with multi-morbidity (Aim 1), as well as through a series of focus groups (aim 2). We will synthesize these data and data from the literature to develop a clinically practical measure of treatment burden (Aim 3), and, finally, we will pilot test this instrument in a clinical setting (Aim 4), as preparation for an R01 study to evaluate the clinical utility of the instrument for improving patient adherence and outcomes for a broader population of patients with multi-morbidity. This work will provide the foundation for a clinical research career focused on improving decision making and outcomes for older people with multimorbidity. Dr. Boyd aims to become an independent clinical investigator dedicated to improving care for older people with multimorbidity. In concert with her sponsors, Dr. Boyd has charted a research path that is a direct extension of her prior work, and will be conducted within a structured career development plan that includes coursework, mentoring, and a multidisciplinary research advisory committee. RELEVANCE: Many older adults have multiple co-existing conditions, but it is not known how to best manage these conditions simultaneously. Dr. Boyd aims to improve clinical decision-making and outcomes for older people with multimorbidity.