Treatment Burden in Older Adults with Diabetes and Multimorbidity

描述（由申请人提供）：慢性疾病在美国老龄化人口中日益流行，这对提供以患者为中心并符合循证指南的医疗保健提出了重大挑战。Boyd博士之前的工作表明，针对多种疾病的老年患者的特定疾病指南的应用受到推荐治疗方案的复杂性、费用和负担以及监测要求的限制。我们老龄化社会的最佳护理需要为医疗复杂的老年患者开发实用的循证治疗模式，允许根据患者偏好和感知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博士建议研究糖尿病合并其他合并症的老年人，作为检查多病患者治疗负担的模型。我们建议通过对指导性护理项目的数据进行二次分析，以及通过一系列焦点小组（目标2）来描述这一人群中治疗负担的领域和调节因素。该项目是一项针对多发病老年人的研究（目标1）。我们将综合这些数据和文献中的数据，以开发一种临床实用的治疗负担测量方法（目标3），最后，我们将在临床环境中对该仪器进行试点测试（目标4），作为一项R01研究的准备，以评估该仪器在提高患者依从性和更广泛的多发病患者预后方面的临床效用。这项工作将为临床研究事业提供基础，重点是改善老年多病患者的决策和结果。博伊德博士的目标是成为一名独立的临床研究者，致力于改善对患有多种疾病的老年人的护理。博伊德博士与她的赞助商合作，绘制了一条研究路径，这是她之前工作的直接延伸，并将在一个结构化的职业发展计划中进行，包括课程、指导和一个多学科研究咨询委员会。

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.