Pilot Core

1处方药的循证使用已经导致健康老龄化的实质性改善。 2尽管如此，患者和提供者对药物的使用仍然不理想。许多患者不是 三是坚持以人为本，坚持以人为本。 4开始适当的治疗，几乎一半的人没有长期坚持;其他人可能会接受- 5种危险药物，风险和益处的平衡不利。结果：可预防的不良反应 6中老年人的健康结果和健康支出。 7虽然许多因素影响处方药的次优使用，但个人、人际和 8个制度性行为是核心。因此，解决这些问题的现有干预措施试图 9.提醒、奖励、激励、简化或改变行为。不幸的是，这些干预措施只 10是适度有效的，即使在那些有效的，行为改变很少是持续的， 11长期这一结果可以解释为设计时缺乏整合行为原则 12项干预措施，有限地侧重于评价如何长期提供这些措施，以及固有的挑战 13在人口规模上提供精确和个性化的行为改变。 14因此，布莱根妇女医院Roybal使用行为优化治疗中心 15.科学将侧重于持续改变行为的专题领域，具体目标如下： 16创建一个转化研究计划，以开发原则驱动的，有效的，实用的，可扩展的， 17个可持续的行为干预措施，以加强适当的处方和使用循证 （2）战略指导和提供科学监督，项目管理，财政和 19.提供业务支持，确保中心资助的试点项目顺利完成 （3）开展严格的试点研究，评估原则驱动的干预措施， 21通过试点核心来维持使用循证药物的行为改变。 22.第一年的拟议试点将是第一阶段研究，包括第0阶段的组成部分，评估原则是- 23驱动干预，通过强化学习和重复提示奖励优化信息框架， 24、改善药物治疗不及时。随后几年的试点将特别征求申请， 25解决其他行为（即处方不足和过量），更广泛的健康状况，影响 26健康老龄化，包括认知障碍，并可以在其他实践环境和交付进行 27个系统，包括医疗保险公司和大型雇主。 28罗伊巴尔行为科学治疗优化中心的预期影响是， 29将制定原则驱动的干预措施，这些措施将很容易转化为健康老龄化的改善， 30还推进了我们对如何有效维持健康行为的基本理解。

1 The evidence-based use of prescription medications has led to substantial improvement in healthy aging. 2 Despite this, the use of medications by patients and providers remains suboptimal. Many patients are not 3 prescribed guideline-recommended therapies from which they would benefit; among those for whom 4 appropriate treatment is initiated, almost half do not adhere over the long-term; and, others receive potentially- 5 hazardous medications with an unfavorable balance of risks and benefits. The result: preventable adverse 6 health outcomes and health spending for middle-aged and older adults. 7 While many factors influence the suboptimal use of prescription medications, individual, interpersonal and 8 institutional behaviors are central. As a result, existing intervention to address these issues have attempted to 9 remind, reward, motivate, simplify or otherwise change behavior. Unfortunately, these interventions have only 10 been modestly effective and even among those that are effective, behavior change is rarely sustained over the 11 long-term. The results can be explained by the lack of integrating behavioral principles when designing 12 interventions, a limited focus on evaluating how to deliver them over the long term, and the inherent challenges 13 in delivering precise and personalized behavior change at population scale. 14 Thus, the Brigham and Women's Hospital Roybal Center for Therapeutic Optimization using Behavioral 15 Science will focus on the thematic area of sustaining behavior change, with the following specific aims: (1) to 16 create a translational research program for the development of principle-driven, potent, practical, scalable and 17 sustainable behavioral interventions to enhance the appropriate prescribing and use of evidence-based 18 medications; (2) to strategically direct and to provide scientific oversight, project management, fiscal and 19 operational support to ensure the successful completion of pilot projects funded by the Center through the 20 Administrative Core; and (3) to conduct rigorous pilot studies evaluating principle-driven interventions that aim 21 to sustain behavior change for the use of evidence-based medications through the Pilot Core. 22 The proposed pilots for Year 1 will be Stage I studies, with Stage 0 components, evaluating principle- 23 driven interventions, optimizing message framing through reinforcement learning and repetition-cue-rewards, 24 to improve medication non-adherence. Pilots in subsequent years will specifically solicit applications that 25 address other behaviors (i.e. under and over-prescribing), a broader range of health conditions that impact 26 healthy aging, including cognitive impairment, and that can be conducted in other practice settings and delivery 27 systems, including with health insurers and large employers. 28 The expected impact of the Roybal Center for Therapeutic Optimization using Behavioral Science is that it 29 will develop principle-driven interventions that will readily translate to improvements in healthy aging and will 30 also advance our fundamental understanding of how health behaviors can be effectively sustained.