ProvisionofPreventiveServicesintheComplexPatient：在复杂的病人提供预防服务.pptVIP

Provision of Preventive Services in the Complex Patient AHRQ Annual Meeting September 9, 2008 The Issue Aging American population ? prevalence and burden of chronic illnesses Most quality metrics designed for the uncomplicated case Goals of the Funding Opportunity Inform prioritization of guidelines, whether for prevention or disease management, in order to: Maximize effective care Avoid inappropriate incentives for clinicians Respect patient autonomy and choice in the setting of a limited life span Three  Study Types Envisioned Descriptive Epidemiology Analytic Epidemiology Modeling Descriptive Epidemiology Large data set analyses (population surveys, medical databases, EHR, insurance claims) Chronic illnesses needing Natural history Impact on quality of life over time Life expectancy Cumulative burden of therapies over time Number and types of medications Other recommended treatments Services for tertiary prevention Analytic Epidemiology Retrospective cohort designs Assess benefits and harms of preventive or therapeutic interventions In “real world” settings for patients who have multiple chronic co-morbid conditions Require sufficient clinical data and innovative statistical techniques to determine the relative positive and negative impacts of prevention/therapy in a populations with co-morbid illness Modeling studies Decision models and cost-effectiveness analysis Project impact of recommended therapies and preventive services on patients with two or more co-morbid chronic conditions Models sufficiently comprehensive to model the impact of the co-morbid illness on issues of competing morbidity and/or mortality benefits and harms of the intervention R21 Grant Program 2008 funds $ 3.7 million 18 awards R21 : exploratory research Second phase planned for 2010 to build on results Today’s Presenters ‘Complex Patient’ R21 grantees Laura M. De Castro MD; Duke U. “Relationship of Depression to Sickle Cell Disease Severity, Health Car