The increasing prevalence of chronic disease in the aging U.S. population presents substantial challenges to delivering medical care that is both patient-centered and consistent with evidence-based guidelines. Dr. Boyd's prior work demonstrated that the application of disease-specific guidelines to older patients with multimorbidity is limited by the complexity, expense, and burden ofthe recommended therapeutic regimens and monitoring requirements. Optimal care for our aging society entails the development of practical evidence-based treatment models for medically-complex older patients that permit flexible goal-setting according to patient preferences and perceived treatment burden. The overall goal of this project is therefore to develop a practical tool for assessing treatment burden among older patients with multimorbidity, to assist in medical decision making. Toward this end, Dr. Boyd proposes to study older individuals with an index diagnosis of diabetes in combination with other comorbid conditions as a model for examining treatment burden in multimorbidity. We propose to characterize the domains and moderators of treatment burden in this population via a secondary analysis of data from the Guided Care project, a study of older adults with multi-morbidity (Aim 1), as well as through a series of focus groups (aim 2). We will synthesize these data and data from the literature to develop a clinically practical measure of treatment burden (Aim 3), and, finally, we will pilot test this instrument in a clinical setting (Aim 4), as preparation for an ROl study to evaluate the clinical utility of the instrument for improving patient adherence and outcomes for a broader population of patients with multi-morbidity. This work will provide the foundation for a clinical research career focused on improving decision making and outcomes for older people with multimorbidity. Dr.
Boyd aims to become an independent clinical investigator dedicated to improving care for older people with multimorbidity. In concert with her sponsors, Dr. Boyd has charted a research path that is a direct extension of her prior work, and will be conducted within a structured career development plan that includes coursework, mentoring, and a multidisciplinary research advisory committee.

Public Health Relevance

Many older adults have multiple co-existing conditions, but it is not known how to best manage these conditions simultaneously. Dr.
Boyd aims to improve clinical decision-making and outcomes for older people with multimorbidity.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAG1-ZIJ-4 (M1))
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King, Jonathan W
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Pollack, Craig Evan; Blackford, Amanda L; Schoenborn, Nancy L et al. (2016) Comparing Prognostic Tools for Cancer Screening: Considerations for Clinical Practice and Performance Assessment. J Am Geriatr Soc 64:1032-8
Fabbri, Elisa; Tanaka, Toshiko; An, Yang et al. (2015) Loss of Weight in Obese Older Adults: A Biomarker of Impending Expansion of Multimorbidity? J Am Geriatr Soc 63:1791-7
Schoenborn, Nancy L; Boyd, Cynthia M; McNabney, Matthew et al. (2015) Current Practices and Opportunities in a Resident Clinic Regarding the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 63:1645-51
St Sauver, Jennifer L; Boyd, Cynthia M; Grossardt, Brandon R et al. (2015) Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open 5:e006413
Chamberlain, Alanna M; St Sauver, Jennifer L; Gerber, Yariv et al. (2015) Multimorbidity in heart failure: a community perspective. Am J Med 128:38-45
Wolff, Jennifer L; Boyd, Cynthia M (2015) A Look at Person- and Family-Centered Care Among Older Adults: Results from a National Survey [corrected]. J Gen Intern Med 30:1497-504
Safarpour, Delaram; Thibault, Dylan P; DeSanto, Cori L et al. (2015) Nursing home and end-of-life care in Parkinson disease. Neurology 85:413-9
Stegeman, Inge; Bossuyt, Patrick M; Yu, Tsung et al. (2015) Aspirin for Primary Prevention of Cardiovascular Disease and Cancer. A Benefit and Harm Analysis. PLoS One 10:e0127194
Puhan, Milo A; Yu, Tsung; Stegeman, Inge et al. (2015) Benefit-harm analysis and charts for individualized and preference-sensitive prevention: example of low dose aspirin for primary prevention of cardiovascular disease and cancer. BMC Med 13:250
Schoenborn, Nancy L; Boyd, Cynthia; Cayea, Danelle et al. (2015) Incorporating prognosis in the care of older adults with multimorbidity: description and evaluation of a novel curriculum. BMC Med Educ 15:215

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