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会计学1ProvisionofPreventiveServicesintheComplexPatient在复杂的病人提供预防服务
The IssueAging American population? prevalence and burden of chronic illnessesMost quality metrics designed for the uncomplicated case第1页/共9页
Goals of the Funding OpportunityInform prioritization of guidelines, whether for prevention or disease management, in order to:Maximize effective careAvoid inappropriate incentives for cliniciansRespect patient autonomy and choice in the setting of a limited life span第2页/共9页
Three Study Types EnvisionedDescriptive EpidemiologyAnalytic EpidemiologyModeling第3页/共9页
Descriptive EpidemiologyLarge data set analyses (population surveys, medical databases, EHR, insurance claims)Chronic illnesses needingNatural history Impact on quality of life over time Life expectancy Cumulative burden of therapies over timeNumber and types of medicationsOther recommended treatmentsServices for tertiary prevention 第4页/共9页
Analytic EpidemiologyRetrospective 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第5页/共9页
Modeling studiesDecision models and cost-effectiveness analysisProject 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 mortalitybenefits and harms of the intervention 第6页/共9页
R21 Grant Program2008 funds $ 3.7 million18 awardsR21 : exploratory researchSecond phase planned for 2010 to build on results第7页/共9页
Today’s Presenters ‘Complex Patient’ R21 granteesLaura M. De Castro MD; Duke U.“Relationship of Depression to Sickle Cell Disease Severity, Health Care Utilization and Quality of Life” M
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