Treatment Burden in Complex Older Patients as a Target for Intervention

描述(由申请人提供)：复杂的老年患者对提供以指南为基础和以患者为中心的医疗保健提出了重大挑战。在衡量诊断或治疗慢性病的测试或治疗计划的风险、负担和好处时，几乎没有可用的信息来指导健康状况复杂的患者和他或她的医生。尽管已知治疗负担与患者在单一疾病和生命末期的医疗决策和生活质量的相关性，但尚无评估治疗负担的措施可用于改善以患者为中心的多种慢性病患者的决策。治疗负担在本申请中定义为患者和照顾者投入到医疗保健管理任务中的行动和资源的总重量，包括努力、时间和自付成本。了解复杂患者所经历的治疗负担对于提供优先的、以患者为中心的医疗护理至关重要。我们建议确定复杂的健康状况如何与治疗负担相关，在多病患者中，治疗负担是作为自我报告的医疗管理任务困难的存在和程度来操作的。我们使用横断面和纵向数据分析进一步研究患者激活是否改变了这种关系，以及治疗负担如何与健康相关的生活质量和护理质量相关。具体地说，我们建议使用一项正在进行的老年人多病成人研究的数据来调查以下目的：1)不同的共存疾病模式如何与治疗负担相关，2)治疗负担的存在和大小之间的联系，以及a)与身体和心理健康相关的生活质量，以及b)患者报告的慢性病护理质量，以及3)患者活动的变化和治疗负担的变化，以及b)治疗负担的变化和与身心健康相关的生活质量的变化之间的关系，和c)治疗负担的变化和患者报告的18个月慢性病护理质量评级的变化。如果研究假设得到证实，这项研究将为开发包括评估、减少和管理治疗负担的干预措施奠定必要的基础工作，以改善以患者为中心的决策，这反过来将有利于依从性、医患沟通、与健康相关的生活质量和护理质量。

DESCRIPTION (provided by applicant): Complex older patients present substantial challenges to delivering medical care that is both guideline-based and patient-centered. There is little information available to guide a patient with complex health status and his or her physicians when they weigh the risks, burdens and benefits of a test or treatment plan to diagnose or treat chronic diseases. Despite the known relevance of treatment burden to patients' medical decision-making and quality of life in the settings of single diseases and at the end of life, there are no measures to assess treatment burden that can be used to improve patient-centered decision-making for patients with multiple chronic diseases. Treatment burden is defined in this application as the aggregate weight of the actions and resources patients and caregivers devote to health care management tasks, including effort, time, and out-of-pocket costs. Understanding the treatment burden experienced by complex patients is essential to delivering prioritized, patient-centered medical care. We propose to identify how complex health status is associated with treatment burden, operationalized as the presence and magnitude of self- reported difficulty with heath care management tasks, in multimorbid patients. We further investigate whether patient activation modifies this relationship, and, how treatment burden is related to health-related quality of life and quality of care using both cross-sectional and longitudinal data analyses. Specifically, we propose to use data from an ongoing study of older, multimorbid adults to investigate the following aims: 1) how different patterns of co-existing conditions are associated with treatment burden, 2) the association between presence and magnitude of treatment burden, and a) physical and mental-health related quality of life, and b) patient-reported quality of chronic illness care, and 3) the relationship between a) changes in patient activation and changes in treatment burden, and b) changes in treatment burden and changes in physical and mental health-related quality of life, and c) changes in treatment burden and changes in the ratings of patient-reported quality of chronic illness care over 18 months. If study hypotheses are substantiated, this study will lay the necessary ground work to develop an intervention consisting of assessing, reducing and managing treatment burden to improve patient-centered decision-making, which in turn should benefit adherence, physician-patient communication, health-related quality of life and quality of care.