Health Outcome Effects of Common Medications in Elders with Multiple Conditions

常见药物对患有多种疾病的老年人健康结果的影响

• 批准号: 8726278
• 负责人: Heather Gwynn Allore
• 金额: $ 20.81万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8726278
• 关键词: Address; Affect; Area; Cessation of life; Chronic; Clinical; Complex; Data; Decision Making; Detection; Elderly; Etiology; Future; Guidelines; Health; Individual; Investigation; Joints; Medicare; Methodology; Methods; Modeling; Morbidity - disease rate; Observational Study; Older Population; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Polypharmacy; Population; Population Attributable Risks; Population Heterogeneity; Relative (related person); Research; Sampling; Statistical Methods; Surveys; Survivors; Symptoms; Time; Work; analytical method; beneficiary; clinical decision-making; clinically relevant; cohort; comparative; comparative effectiveness; effectiveness research; evidence base; improved; innovation; member; multiple chronic conditions; novel; randomized trial; treatment effect

DESCRIPTION (provided by applicant): To inform clinical decision-making for persons with multiple chronic conditions (MCC), we must compare the effects of treatments across conditions. In this study, we go beyond the question of comparative benefit of treatments for a single condition on single condition-specific outcomes to begin exploring the comparative effectiveness of treatments across multiple conditions on multiple universal health outcomes (e.g. function, symptoms, and survival) that are meaningful to patients and that are affected by all health conditions. Multiple universal outcomes are important to explore because treatments may affect outcomes differently and older adults with MCC vary in their health outcome priorities. While complex, this line of investigation is responsive to the RFA-AG-13-003 and of utmost relevance for older individuals with MCC. The project builds on recent work in which we have: 1) identified a set of universal health outcomes; 2) determined the effect of several common conditions on these outcomes; 3) developed a method for determining the % contribution to death of co-occurring conditions; 4) identified the most common pairs of competing conditions; and 5) determined the effects of treatment for one condition on a potentially competing condition. In conducting this work, we have come to appreciate the methodological challenges that help explain the dearth of research in this area despite its clinical importance. The proposed methodology builds on our recent work in adapting joint modeling of longitudinal outcomes and developing the longitudinal extension of the average attributable fraction. Using innovative analytical methods, the Specific Aims are to: 1) estimate the effect of the 9 most commonly used guideline recommended medication classes for a set of common and morbid chronic conditions on 5 universal health outcomes; and 2) estimate the percent contribution of each medication to each universal outcome. Participants will be members of the large, well-characterized, nationally representative Medicare Current Beneficiary Survey (MCBS) cohort who have e 2 of the 9 study conditions. From a clinical perspective, this line of investigation eventually will allow an evidence-based approach to polypharmacy for patients with MCC by identifying medications with the best overall benefits. Results will inform future studies by introducing new methods, identifying promising treatments to compare in persons with MCC, and determining effect size and power estimates. Because MCBS represents the national older population with variable combinations of MCC, results will provide a population-level estimate of the relative effects of the study medications.

描述（由申请人提供）：为了为多种慢性病 (MCC) 患者的临床决策提供信息，我们必须比较不同病症的治疗效果。在这项研究中，我们超越了单一疾病治疗对单一特定疾病结果的相对效益问题，开始探索多种疾病治疗对多种普遍健康结果（例如功能、症状和生存）的比较有效性，对患者有意义并且受到所有健康状况的影响。探索多种普遍结果非常重要，因为治疗方法可能会以不同方式影响结果，并且患有 MCC 的老年人的健康结果优先级也有所不同。虽然很复杂，但这一系列调查响应 RFA-AG-13-003，并且与患有 MCC 的老年个体最为相关。该项目建立在我们最近的工作基础上：1）确定了一系列全民健康成果； 2) 确定几种常见条件对这些结果的影响； 3) 开发了一种确定同时发生的疾病对死亡的贡献百分比的方法； 4）确定最常见的竞争条件对； 5) 确定一种病症的治疗对潜在竞争病症的影响。在开展这项工作的过程中，我们逐渐意识到方法论上的挑战，这些挑战有助于解释尽管该领域具有临床重要性，但研究的缺乏。所提出的方法建立在我们最近在调整纵向结果的联合模型和开发平均归因分数的纵向延伸方面的工作基础上。使用创新的分析方法，具体目标是： 1) 评估针对一组常见和病态慢性病的 9 种最常用指南推荐药物类别对 5 种普遍健康结果的影响； 2) 估计每种药物对每个普遍结果的贡献百分比。参与者将是大型、特征明确、具有全国代表性的 Medicare 当前受益人调查 (MCBS) 队列的成员，他们具有 9 种研究条件中的 e 2 种。从临床角度来看，这一系列的研究最终将通过识别具有最佳总体效益的药物，为 MCC 患者提供基于证据的多药治疗方法。结果将为未来的研究提供信息，包括引入新方法、确定有希望的治疗方法以对 MCC 患者进行比较，以及确定效果大小和功效估计。由于 MCBS 代表具有不同 MCC 组合的全国老年人口，因此结果将提供研究药物相对效应的人口水平估计。