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）：为了为具有多种慢性病（MCC）的人提供临床决策，我们必须比较跨疾病的治疗的影响。在这项研究中，我们超越了治疗对单个条件特异性结果的治疗的比较益处的问题，可以开始探索多种疾病对多种普遍健康结果（例如功能，症状和生存）的比较有效性，这些疗效对患者有意义，并受到所有健康状况的影响。多种普遍的结果对于探索很重要，因为治疗可能会对结果的影响有所不同，而患有MCC的老年人的健康结果优先级各不相同。虽然复杂，但这种调查对RFA-AG-13-003的响应和对MCC的老年人的最大相关性。该项目以我们拥有的最新工作为基础：1）确定了一组普遍的健康结果； 2）确定了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条件死亡的贡献百分比的方法； 4）确定了最常见的竞争条件； 5）确定了一种条件治疗对潜在竞争条件的影响。在进行这项工作时，我们已经欣赏了方法论上的挑战，这些挑战有助于解释该领域的研究，尽管其临床重要性。拟议的方法基于我们最近在适应纵向结果的联合建模并发展平均归因分数的纵向扩展方面的工作。使用创新的分析方法，具体目的是：1）估计9个最常用的指南推荐药物类别对一组常见和病态的慢性疾病对5种普遍健康结果的影响； 2）估计每种药物对每种普遍结果的贡献百分比。参与者将成为具有9个研究条件中E 2的大型，熟悉，全国代表性的医疗保险当前受益人调查（MCBS）的成员。从临床角度来看，这种调查最终将通过确定具有最佳总体好处的药物来为MCC患者提供基于证据的方法。结果将通过引入新方法，确定有希望的治疗方法来为未来的研究提供信息，以比较患有MCC的人，并确定效果大小和功率估计。由于MCB代表具有MCC的可变组合的全国老年人群，因此结果将对研究药物的相对影响提供人群级别的估计。