Patient and System-Level Determinants of Oral Anticoagulation Use in Atrial Fibrillation

心房颤动口服抗凝药使用的患者和系统水平决定因素

基本信息

批准号：
10458104
负责人：
Inmaculada Hernandez
金额：
$ 15.97万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-15 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10458104
关键词：
Address Adherence Affect Anticoagulants Anticoagulation Applications Grants Area Atrial Fibrillation Cardiovascular Diseases Cardiovascular system Cause of Death Characteristics Clinical Data Data Analyses Diagnosis Direct Costs Educational workshop Elderly Fee-for-Service Plans Geographic Locations Goals Grant Health Care Costs Health Planning Organizations Health Services Research Health system Hypertension Incentives Incidence Insurance Insurance Carriers Insurance Coverage Intervention Ischemic Stroke Lead Learning Longitudinal trends Managed Care Managed Care Programs Manuscripts Measures Mediating Mediation Medical Medical center Medicare Mentored Research Scientist Development Award Mentors Methodology Methods Midwestern United States Modeling Oral Outcome Patient-Focused Outcomes Patients Pattern Peer Review Pennsylvania Pharmaceutical Preparations Pharmaceutical Services Pharmacoepidemiology Pharmacologic Substance Pharmacotherapy Policy Maker Provider Research Research Activity Research Personnel Risk Risk Factors Role Sampling Savings Stroke Stroke prevention Supervision System Testing Time Training Training Activity Translating Universities Ursidae Family Variant Warfarin Writing base beneficiary career data visualization design disability effective intervention experience geographic difference health care delivery implementation intervention improved improved outcome innovation payment pharmacy benefit prevent programs public health relevance skills stroke incidence stroke risk

项目摘要

Project Summary My long-term career goal is to improve outcomes of patients with cardiovascular diseases through optimal medication use. My short-term goal is to address the role of patient and system-level factors on the underuse of oral anticoagulation in atrial fibrillation. The proposed training and research program will put me in a strong positon to become an independent investigator and establish my research group at the intersection of cardiovascular pharmacotherapy, pharmacoepidemiology, and health services research. Candidate: My background in pharmacy and health services research has enabled me to lead 16 first-author peer-reviewed manuscripts. However, I lack advanced methodological skills necessary to evaluate how patient and system-level factors affect oral anticoagulation use. The training proposed in this K01 award will build on my on my background and provide me with the skills I currently lack to conduct the proposed research. Training Plan: This plan includes formal coursework, workshops, seminars and personal mentoring. I will dedicate 75% effort to the training and research activities proposed, under the supervision of my primary mentor Dr. Walid Gellad. Dr. Maria Brooks, Dr. Samir Saba, Dr. William Shrank, and Dr. Joshua Thorpe will be my co-mentors, and Dr. Ashley Naimi will serve as advisor. My specific training goals are: 1) To learn and implement advanced methods, including group-based trajectory modeling, causal mediation analysis, and hierarchical models; 2) To learn the use of spatial data analysis and visualization in health services research; 3) To develop an in-depth understanding of pharmacy benefits management and design of provider payment models, and learn how health services research findings are translated into innovative insurance, health services delivery, and provider payment models in the real-world setting; and 4) To improve my grant writing skills and submit an R01 grant application. Research plan: The overarching theme of this K01 research program is to improve clinical outcomes of atrial fibrillation patients through optimal oral anticoagulation use. My specific aims are to: 1) Describe trajectories of oral anticoagulation use in the 12 months after first atrial fibrillation diagnosis and test whether patient characteristics and region affect trajectories; 2) Quantify to what extent the geographic variation in the incidence of ischemic stroke among atrial fibrillation patients is attributable to the geographic variation in oral anticoagulation initiation and adherence; and 3) Evaluate the effect of type of insurance coverage and insurer- provider payment models on the use and adherence to oral anticoagulation therapy. Impact: The results from this research will guide policymakers on the design and implementation of interventions targeted at mitigating oral anticoagulation underuse.

项目概要我的长期职业目标是通过最佳的方法改善心血管疾病患者的治疗结果药物使用。我的短期目标是解决患者和系统级因素对使用不足的影响口服抗凝药治疗心房颤动的研究进展。拟议的培训和研究计划将使我处于一个强有力的位置成为一名独立调查员并在交叉点建立我的研究小组心血管药物治疗、药物流行病学和卫生服务研究。候选人：我在药学和健康服务研究方面的背景使我能够领导 16 名第一作者同行评审的手稿。然而，我缺乏评估患者如何接受治疗所需的先进方法技能。系统层面的因素影响口服抗凝药物的使用。 K01 奖项中提出的培训将建立在我的背景，并为我提供目前缺乏的技能来进行拟议的研究。培训计划：该计划包括正式课程、讲习班、研讨会和个人指导。我会在我的主要负责人的监督下，将 75% 的精力投入到拟议的培训和研究活动中导师瓦利德·盖拉德博士。 Maria Brooks 博士、Samir Saba 博士、William Shrank 博士和 Joshua Thorpe 博士将我的共同导师阿什利·奈米 (Ashley Naimi) 博士将担任顾问。我的具体培训目标是： 1）学习和实施先进的方法，包括基于群体的轨迹建模、因果中介分析和层次模型； 2）学习空间数据分析和可视化在卫生服务研究中的运用； 3) 深入了解药品福利管理和提供者付款设计模型，了解健康服务研究成果如何转化为创新保险、健康现实环境中的服务交付和提供商支付模式； 4）改进我的资助写作技能并提交 R01 补助金申请。研究计划：K01研究计划的首要主题是改善心房疾病的临床结果通过最佳口服抗凝药物使用来治疗颤动患者。我的具体目标是：1）描述轨迹首次心房颤动诊断后 12 个月内口服抗凝药物的使用情况，并测试患者是否特征和区域影响轨迹； 2) 量化地理差异的程度心房颤动患者缺血性卒中的发病率归因于口腔疾病的地理差异抗凝开始和坚持； 3) 评估保险范围和保险公司类型的影响- 提供者关于使用和坚持口服抗凝治疗的支付模式。影响：这项研究的结果将指导政策制定者设计和实施旨在缓解口服抗凝药物使用不足的干预措施。