Enhancing Pediatric Treatment Adherence and Health Outcomes

项目摘要 该提案要求继续支持“提高儿科治疗依从性和健康 结果”（T32 HD 068223）博士后培训计划，培养医学博士。和博士研究人员 在开发关于坚持医疗的创新性、高影响力研究方面发挥领导作用 和慢性病自我管理，这将提高慢性病儿童的健康成果。 现代医疗手段改善了大量儿童和青少年的健康状况 慢性病患者然而，改善儿童健康的一个最关键的障碍是， 在他们的一生中的结果是不遵守规定的医疗。所指出 根据世界卫生组织（WHO），治疗不依从性非常普遍（儿科患者的发生率≥ 50%） 慢性病人群），并对儿童健康和医疗保健费用产生重大负面影响。 需要继续进行创新和临床相关研究，以缩小健康与 通过更佳的治疗依从性可能实现的结局，以及当前 实践NIH计划优先事项和申请要求，科学共识会议和学术 所有的综述都指出了儿科坚持治疗研究的重要性。一个关键的障碍， 儿科依从性和慢性病管理研究的科学进展是缺乏 有才华，训练有素的研究人员谁是致力于发展创新，高影响力的职业生涯 儿科人群的治疗依从性和自我管理研究。最有前途的 解决这一需求和改善儿童健康的方法是发展创新的跨学科研究培训 培训治疗依从性和自我管理研究领域领导者的计划。这是重点 这个T32项目。到目前为止，我们已经培训了22名研究员（18名毕业生，4名正在受训），他们是 在儿科依从性和自我管理方面发展有前途的独立研究事业。 具体的培训创新涉及生物医学、行为学、生物统计学和健康的整合 服务/成果研究，并反映在一个全面的培训课程，包括经验 研究机会。研究创新包括新的坚持评估方法， 涉及旨在加强儿童和青少年参与的技术的干预措施， 干预措施的效力和持续时间，并覆盖无法轻易获得的各种人群 传统的临床方法。新颖的研究培训也加强了项目创新 有机会评估儿科患者依从性促进干预措施的比较有效性 慢性病管理，以整合依从性测量的客观方法（例如，行为， 药理学，技术），并进行先进的统计分析，以评估 坚持促进干预儿童的健康结果。

PROJECT SUMMARY This proposal requests continued support for the “Enhancing Pediatric Treatment Adherence and Health Outcomes” (T32 HD068223) postdoctoral training program, which trains M.D. and Ph.D. researchers to assume leadership roles in developing innovative, high impact research on adherence to medical treatment and chronic illness self-management that will enhance the health outcomes of children with chronic conditions. Modern medical treatments have improved the health outcomes of large numbers of children and adolescents with chronic conditions. However, one of the most critical remaining barriers to improving children’s health outcomes over the course of their lifetime is nonadherence to prescribed medical treatment. As noted by the World Health Organization (WHO), treatment nonadherence is highly prevalent (rates of ≥ 50% in pediatric chronic illness populations) and has a significantly negative impact on children’s health and health care costs. Continued innovative and clinically relevant research is needed to close the gap between the health outcomes that are potentially achievable with more optimal treatment adherence and those achieved in current practice. NIH program priorities and requests for applications, scientific consensus conferences, and scholarly reviews have all identified the importance of research on pediatric adherence to treatment. A critical barrier to scientific advances in pediatric adherence and chronic illness management research is the shortage of talented, well-trained researchers who are devoting their careers to developing innovative, high impact treatment adherence and self-management research with pediatric populations. One of the most promising ways to address this need and improve child health is to develop innovative interdisciplinary research training programs to train leaders in the field of treatment adherence and self-management research. This is the focus of this T32 program. Thus far, we have trained 22 fellows (18 graduates, 4 current trainees) who are developing promising independent research careers in pediatric adherence and self-management. Specific training innovations involve the integration of biomedical, behavioral, biostatistics, and health services/outcomes research and are reflected in a comprehensive training curriculum including experiential research opportunities. Research innovations include novel methods of adherence assessment and intervention involving technology designed to enhance the engagement of children and adolescents, improve the power and duration of intervention effects, and reach diverse populations who cannot easily access traditional clinic-based approaches. Program innovation is also enhanced by novel research training opportunities to evaluate the comparative effectiveness of adherence promotion interventions in pediatric chronic illness management, to integrate objective methods of adherence measurement (e.g., behavioral, pharmacological, technological) and conduct advanced statistical analyses to evaluate the impact of adherence promotion interventions on children’s health outcomes.