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.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Quantitative Research Career Development Award (K25)
Project #
Application #
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Salive, Marcel
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of North Carolina Chapel Hill
Public Health & Prev Medicine
Schools of Public Health
Chapel Hill
United States
Zip Code
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
Funk, Michele Jonsson; Westreich, Daniel; Wiesen, Chris et al. (2011) Doubly robust estimation of causal effects. Am J Epidemiol 173:761-7
Solomon, D H; Brookhart, M A; Tsao, P et al. (2011) Predictors of very low adherence with medications for osteoporosis: towards development of a clinical prediction rule. Osteoporos Int 22:1737-43
Brookhart, M Alan; Solomon, Daniel H; Glynn, Robert J et al. (2011) Effect of rosuvastatin on hemoglobin levels in patients with anemia and low-grade inflammation: a post hoc analysis of the JUPITER trial. J Clin Pharmacol 51:1483-7
Patrick, Amanda R; Shrank, William H; Glynn, Robert J et al. (2011) The association between statin use and outcomes potentially attributable to an unhealthy lifestyle in older adults. Value Health 14:513-20
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

Showing the most recent 10 out of 53 publications