The five year program of mentored research and training outlined in this proposal is designed to develop Dr. Brookhart, a biostatistician, into an independent investigator working at the intersection of geriatrics, biostatistics, and drug epidemiology. The primary research aim of this proposal is the development and application of hierarchical statistical models for the study of complex patterns of prescription drug use by the elderly, an area of great clinical and policy importance. The data that are available to understand medication use have a multilevel structure consisting of repeated observations on patients who cluster within physicians, practices, and geographic regions. To capture the complex structure of the data and answer important substantive questions about prescription drug use by older patients, we propose to employ modern statistical approaches for the analysis of hierarchical data. With increasing concern over the appropriate use and cost of prescription drugs, particularly with the new Medicare drug benefit, such models of prescribing and adherence can play an important role in improving the use of medications. By understanding common patterns of prescription medication use, targeted and cost-effective quality improvement intervention can be designed. In the final phase of this award the candidate will develop multilevel statistical approaches for creating patient, physician, practice, and region profiles that can be used to target quality improvement interventions that aim to promote more appropriate prescribing and higher levels of patient adherence to effective therapies. Different profiling approaches will be pilot tested and compared as part of a future R01 proposal. The mentored research outlined in this proposal will be complemented by a formal training program that will involve coursework in gerontology, geriatrics, chronic disease epidemiology, theories of health behavior, prescription drug and health care policy, and health services research; regular meetings with mentors and other senior faculty; attendance at seminars, workshops, and academic conferences; and systematic exposure to clinical geriatrics including time spent in outpatient, inpatient, and long-term care environments. ? ? ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Quantitative Research Career Development Award (K25)
Project #
1K25AG027400-01A1
Application #
7148829
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Nayfield, Susan G
Project Start
2006-09-01
Project End
2011-07-31
Budget Start
2006-09-01
Budget End
2007-07-31
Support Year
1
Fiscal Year
2006
Total Cost
$124,595
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Kshirsagar, Abhijit V; Freburger, Janet K; Ellis, Alan R et al. (2013) The comparative short-term effectiveness of iron dosing and formulations in US hemodialysis patients. Am J Med 126:541.e1-541.e14
Costa, Nadiesda A; Kshirsagar, Abhijit V; Wang, Lily et al. (2013) Pretransplantation erythropoiesis-stimulating agent hyporesponsiveness is associated with increased kidney allograft failure and mortality. Transplantation 96:807-13
Choi, Byeong Yeob; Fine, Jason P; Brookhart, M Alan (2013) Practicable confidence intervals for current status data. Stat Med 32:1419-28
Solomon, Daniel H; Iversen, Maura D; Avorn, Jerry et al. (2012) Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial. Arch Intern Med 172:477-83
Stedman, Margaret R; Lew, Robert A; Losina, Elena et al. (2012) A comparison of statistical approaches for physician-randomized trials with survival outcomes. Contemp Clin Trials 33:104-15
Costenbader, Karen H; Desai, Amrita; Alarcon, Graciela S et al. (2011) Trends in the incidence, demographics, and outcomes of end-stage renal disease due to lupus nephritis in the US from 1995 to 2006. Arthritis Rheum 63:1681-8
Curtis, Jeffrey R; Larson, Joseph C; Delzell, Elizabeth et al. (2011) Placebo adherence, clinical outcomes, and mortality in the women's health initiative randomized hormone therapy trials. Med Care 49:427-35
Brookhart, M Alan; Bradbury, Brian D; Avorn, Jerry et al. (2011) The effect of altitude change on anemia treatment response in hemodialysis patients. Am J Epidemiol 173:768-77
Stedman, Margaret R; Gagnon, David R; Lew, Robert A et al. (2011) A SAS macro for a clustered logrank test. Comput Methods Programs Biomed 104:266-70
Stürmer, Til; Jonsson Funk, Michele; Poole, Charles et al. (2011) Nonexperimental comparative effectiveness research using linked healthcare databases. Epidemiology 22:298-301

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