Hierarchical models of prescription drug use in the elderly

老年人处方药使用的分层模型

• 批准号: 7148829
• 负责人: Maurice Alan Brookhart
• 金额: $ 12.46万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7148829
• 关键词: antihypercholesterolemic agent; behavior prediction; behavioral /social science research tag; chemotherapy; comorbidity; cost effectiveness; diphosphonate; extended care; geographic difference; health care model; health care personnel performance; health care quality; health services research tag; human data; human old age (65+); hypertension; low socioeconomic status; model design /development; osteoporosis; patient care management; patient oriented research; statistics /biometry; therapy compliance; thiazide

DESCRIPTION (provided by applicant): The five year program of mentored research and training outlined in this proposal is designed to develop Dr. Brookhart, a biostatistician, into an independent investigator working at the intersection of geriatrics, biostatistics, and drug epidemiology. The primary research aim of this proposal is the development and application of hierarchical statistical models for the study of complex patterns of prescription drug use by the elderly, an area of great clinical and policy importance. The data that are available to understand medication use have a multilevel structure consisting of repeated observations on patients who cluster within physicians, practices, and geographic regions. To capture the complex structure of the data and answer important substantive questions about prescription drug use by older patients, we propose to employ modern statistical approaches for the analysis of hierarchical data. With increasing concern over the appropriate use and cost of prescription drugs, particularly with the new Medicare drug benefit, such models of prescribing and adherence can play an important role in improving the use of medications. By understanding common patterns of prescription medication use, targeted and cost-effective quality improvement intervention can be designed. In the final phase of this award the candidate will develop multilevel statistical approaches for creating patient, physician, practice, and region profiles that can be used to target quality improvement interventions that aim to promote more appropriate prescribing and higher levels of patient adherence to effective therapies. Different profiling approaches will be pilot tested and compared as part of a future R01 proposal. The mentored research outlined in this proposal will be complemented by a formal training program that will involve coursework in gerontology, geriatrics, chronic disease epidemiology, theories of health behavior, prescription drug and health care policy, and health services research; regular meetings with mentors and other senior faculty; attendance at seminars, workshops, and academic conferences; and systematic exposure to clinical geriatrics including time spent in outpatient, inpatient, and long-term care environments.

描述（由申请人提供）：本提案中概述的五年指导研究和培训计划旨在发展生物统计学家布鲁克哈特博士，成为一名在老年医学，生物统计学和药物流行病学交叉点工作的独立研究者。该提案的主要研究目的是开发和应用层次统计模型，用于研究老年人处方药使用的复杂模式，这是一个非常重要的临床和政策重要性领域。可以理解用药使用的数据具有多层结构，该结构包括对聚集在医师，实践和地理区域中的患者的重复观察。为了捕获数据的复杂结构并回答有关老年患者处方药使用的重要实质性问题，我们建议采用现代统计方法来分析层次数据。随着对处方药的适当使用和成本的关注，尤其是在新的Medicare药物益处，这种处方和依从性模型可以在改善药物使用中发挥重要作用。通过了解使用处方药的常见模式，可以设计针对性和成本效益的质量改进干预措施。在该奖项的最后阶段，候选人将开发多层次的统计方法来创建患者，医师，实践和地区概况，这些方法可用于针对质量改进干预措施，以促进更适当的处方和更高水平的患者遵守有效疗法。作为未来R01提案的一部分，将对不同的分析方法进行试点测试和比较。该提案中概述的指导研究将由一项正式培训计划进行补充，该计划将涉及老年医学，老年医学，慢性病流行病学，健康行为理论，处方药和卫生保健政策以及卫生服务研究的课程；与导师和其他高级教师的定期会议；参加研讨会，研讨会和学术会议；以及系统地接触临床老年病，包括在门诊，住院和长期护理环境中花费的时间。