Decision Making for Cardiovascular Therapy in Adults with Mild Cognitive Impairment

轻度认知障碍成人心血管治疗的决策

• 批准号: 9519775
• 负责人: Deborah Levine
• 金额: $ 72.37万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9519775
• 关键词: Activities of Daily Living; Acute; Acute myocardial infarction; Address; Adult; Affect; Aftercare; American; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical; Cognitive; Complex; Data; Data Analyses; Decision Making; Dementia; Development; Elderly; Event; Face; Goals; Guidelines; Hand; Health; Health Services Research; Health and Retirement Study; Heart; Human; Impaired cognition; Intervention; Interview; Ischemic Stroke; Knowledge; Lead; Life Expectancy; Link; Longitudinal cohort; Measures; Medicare; Methods; Michigan; Mission; Modeling; Morbidity - disease rate; Outcome; Patient Preferences; Patient-Focused Outcomes; Patients; Physicians; Population; Public Health; Quality of life; Recommendation; Rehabilitation therapy; Research; Research Proposals; Risk; Secondary Prevention; Secondary to; Stroke; Structure; Surveys; Testing; Time; Translating; Treatment outcome; United States National Institutes of Health; Universities; Work; advanced dementia; cardiovascular disorder risk; care outcomes; clinical decision-making; cohort; design; disability; effective therapy; experience; improved; innovation; mild cognitive impairment; mortality; novel strategies; older patient; population based; preference; prevent; public health relevance; standard care; stroke treatment; therapy design

 DESCRIPTION (provided by applicant): There is a fundamental gap in understanding how mild cognitive impairment (MCI) influences treatment and decision making for serious illnesses, like cardiovascular disease (CVD), in older patients. Poor understanding of clinical decision making is a critical barrier to the design of interventions to improve the quality and outcomes of CVD care of in older patients with MCI. The long-term goal of this research is to develop, test, and disseminate interventions aimed to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans with MCI. The objective of this application is to determine the extent to which people with MCI are receiving sub-standard care for the two most common CVD events, acute myocardial infarction (AMI) and acute ischemic stroke, increasing the chance of mortality and morbidity in a population with otherwise good quality of life, and to determine how MCI influences patient preferences and physician recommendations for treatment. AMI and acute ischemic stroke are excellent models of serious, acute illnesses with a wide range of effective therapies for acute management, rehabilitation, and secondary prevention. Our central hypothesis is that older adults with MCI are undertreated for CVD because patients and physicians overestimate their risk of dementia and underestimate their risk of CVD. This hypothesis has been formulated on the basis of preliminary data from the applicants' pilot research. The rationale for the proposed research is that understanding how patient preferences and physician recommendations contribute to underuse of CVD treatments in patients with MCI has the potential to translate into targeted interventions aimed to improve the quality and outcomes of care, resulting in new and innovative approaches to the treatment of CVD and other serious, acute illnesses in adults with MCI. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Compare AMI and stroke treatments between MCI patients and cognitively normal patients and explore differences in clinical outcomes associated with treatment differences; and 2) Determine the influence of MCI on patient and surrogate preferences and physician recommendations for AMI and stroke treatment. Under the first aim, a health services research approach- shown to be feasible in the applicants' hands-will be used to quantify the extent and outcomes of treatment differences for AMI and acute ischemic stroke in older patients with MCI. Under the second aim, a multi-center, mixed-methods approach and a national physician survey, which also has been proven as feasible in the applicants' hands, will be used to determine the influence of MCI on patient preferences and physician recommendations for AMI and stroke treatment. This research proposal is innovative because it represents a new and substantially different way of addressing the important public health problem of enhancing the health of older adults by determining the extent and causes of underuse of effective CVD treatments in those with MCI. The proposed research is significant because it is expected to vertically advance and expand understanding of how MCI influences treatment and decision making for AMI and ischemic stroke in older patients. Ultimately, such knowledge has the potential to inform the development of targeted interventions that will help to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans.

 描述（由适用提供）：了解老年患者对严重疾病（例如心血管疾病（CVD））的轻度认知障碍（MCI）如何影响严重疾病的治疗和决策存在根本差距。对临床决策的了解不足是设计干预措施以改善老年MCI患者CVD护理的质量和结果的关键障碍。这项研究的长期目标是开发，测试和传播干预措施，旨在提高CVD护理的质量和结果，并减少MCI老年美国人中与CVD相关的残疾。该应用的目的是确定MCI患者对两个最常见的CVD事件（急性心肌中风）接受不合标准的护理程度，增加了具有良好生活质量的人群死亡率和发病率的机会，并确定MCI如何影响患者的偏好和身体的治疗建议。 AMI和急性缺血性中风是严重，急性疾病的出色模型，具有广泛的有效疗法，可用于急性管理，康复和次要预防。我们的中心假设是，患有MCI的老年人被低估了CVD，因为患者和医生高估了痴呆症的风险，并低估了其CVD的风险。这个假设是根据申请人的初步研究的初步数据提出的。拟议研究的理由是，了解患者的偏好和身体建议如何导致MCI患者中CVD治疗的不足，有可能转化为旨在改善护理质量和成果的有针对性干预措施，从而导致新的和创新的方法来治疗MCI的CVD治疗和其他严重的急性疾病。在强大的初步数据的指导下，将通过追求两个具体目的来检验该假设：1）比较MCI患者与认知正常患者之间的AMI和中风治疗，并探索与治疗差异相关的临床结果的差异； 2）确定MCI对AMI和中风治疗的患者和替代偏好和物理建议的影响。在第一个目标下，一种卫生服务研究方法 - 证明在申请人的手中是可行的，可用于量化MCI老年患者的AMI和急性缺血性中风的治疗差异的程度和结果。在第二个目标下，多中心的混合方法方法和一项国家的物理调查（也被证明在申请人手中是可行的）将用于确定MCI对患者偏好和AMI和中风治疗的物理建议的影响。该研究建议具有创新性，因为它代表了一种新的且实质上不同的方式，可以通过确定MCI患者中有效的CVD治疗的程度和原因来解决重要的公共卫生问题，以提高老年人的健康状况。拟议的研究很重要，因为预计它将垂直提高和扩展对MCI如何影响老年患者对AMI和缺血性中风的治疗和决策的理解。最终，此类知识有可能告知有针对性的干预措施的发展，这将有助于提高CVD护理的质量和结果，并减少美国老年人中与CVD相关的残疾。