Towards Understanding the Patient Experience of Overuse of Medical Resources

 描述（由申请人提供）：美国的健康结果落后于其他发达国家，尽管卫生支出异常高，而且还在增长。这种差异导致许多人得出结论，医疗服务被过度使用，这是由患者，提供者和机构决定因素的完美风暴驱动的现象。过度使用被定义为在潜在伤害超过潜在受益的情况下提供护理。虽然过度使用在整个医疗保健系统中普遍存在，但美国老年人可能特别容易接受潜在危害超过潜在益处的服务。这可能包括在存在导致大量死亡竞争风险的条件时使用筛选测试，在生命终了时提供的治疗不影响疾病过程或生活质量，在没有认识到老年患者因虚弱而存在异质性的情况下提供的治疗，多病患者的多种药物，以及多名专家参与护理时的护理协调失败。过度使用医疗保健会使患者面临不良后果的风险，并产生全系统的后果，但患者，他们的家人和他们的临床医生对此认识不足。我寻求这个K24奖，以支持我的努力，作为一个研究人员和有才华的年轻研究人员的导师，因为我们的工作，以了解过度使用医疗保健和推进实践“吝啬医学”，一个术语反映了谨慎提供必要的照顾病人的好。这个职业发展奖的总体目标是通过节俭的医疗保健使用，努力减少对老年患者的伤害，同时，提高我在以患者为中心的成果研究方面的技能，并培养该领域的下一代研究人员。与我的学员、导师和同事一起，我将：a）系统地回顾有关过度使用医疗资源的决定因素的文献; B）通过焦点小组进行定性研究，以了解患者如何看待过度使用及其危害; c）使用状态偏好方法来了解老年患者如何决定他们使用医疗保健，以及在老年综合征存在时如何变化，以及d）用额外的数据源验证约翰霍普金斯过度使用指数，并探索建立责任医疗组织对老年患者过度使用资源的影响。该奖项的影响预计将完成重要的研究，以告知老年人的护理，一群年轻的研究人员的技能，以解决这些主题和其他相关的改进护理服务的进步，以及我的技能的个人进步，使我可以成为一个更有效的研究人员和导师。

 DESCRIPTION (provided by applicant): Health outcomes in the United States lag behind other developed nations despite health expenditures that are exceptionally high and growing. This disparity has led many to conclude that healthcare services are overused, a phenomenon driven by a perfect storm of patient, provider, and institutional determinants. Overuse has been defined as the provision of care in circumstances where the potential for harm exceeds the potential for benefit. While overuse is pervasive throughout the healthcare system, older Americans may be particularly at risk for receipt of services where the potential for harm exceeds the potential for benefit. This may include the use of screening tests when there are conditions causing substantial competing risks for death, therapies delivered at end-of-life that do not impact disease course or quality of life, therapies delivered without recognition of the heterogeneity among older patients due to frailty, polypharmacy in multimorbid patients, and care coordination failure when multiple specialists are involved in care. Overuse of healthcare puts patients at risks of adverse outcomes and has system-wide consequences, and yet this is poorly appreciated by patients, their families, and their clinicians. I seek this K24 award to support my effort as a researcher and mentor of talented young investigators as we work to understand overuse of healthcare and advance the practice of "parsimonious medicine", a term reflecting the prudent delivery of care necessary for the patient's good. The overarching aim of this career development award is to work towards harm reduction for older patients through parsimonious healthcare use, and concurrently, advance my skills in patient centered outcomes research and train the next generation of researchers in this field. With my mentees, mentors, and colleagues, I will: a) systematically review the literature about determinants of overuse of healthcare resources; b) conduct a qualitative study via focus groups to understand how patients perceive overuse and its harms; c) use stated-preference methods to understand how older patients make decisions about their use of healthcare and how this varies in the presence of geriatric syndromes, and d) validate the Johns Hopkins Index of Overuse with additional data sources and explore the impact of Accountable Care Organization establishment on overuse of resources in older patients. The impact of this award is expected to be the completion of important research to inform the care of older adults, the advancement of a cohort of young investigators with skills to address these topics and others relevant to improved care delivery, and the personal advancement of my skills so that I can be an ever more effective researcher and mentor.