This proposal requests continued support for the ?Enhancing Pediatric Treatment Adherence and Health Outcomes? (T32 HD068223) postdoctoral training program, which trains M.D. and Ph.D. researchers to assume leadership roles in developing innovative, high impact research on adherence to medical treatment and chronic illness management that will enhance the health outcomes of children with chronic conditions. Modern medical treatments have improved the health outcomes of large numbers of children and adolescents with chronic conditions. However, one of the most critical remaining barriers to improving children's health outcomes over the course of their lifetime is nonadherence to prescribed medical treatment. As noted by the World Health Organization (WHO), treatment nonadherence is highly prevalent (rates of ? 50% in pediatric chronic illness populations) and has a significantly negative impact on children's health and health care costs. Continued innovative and clinically relevant research is needed to close the gap between the health outcomes that are potentially achievable with more optimal treatment adherence and those achieved in current practice. NIH program priorities and requests for applications, scientific consensus conferences, and scholarly reviews have all identified the critical importance of research on pediatric adherence to treatment. A critical barrier to scientific advances in pediatric adherence and chronic illness management research is the shortage of talented, well-trained researchers who are devoting their careers to developing innovative, high impact treatment adherence and chronic illness management research with pediatric populations. One of the most promising ways to address this need and improve child health is to develop innovative interdisciplinary research training programs to train leaders in the field of treatment adherence and chronic illness management research. This is the focus of this T32 program. Thus far, we have trained several fellows who are developing promising independent research careers in pediatric adherence and chronic illness management. Specific training innovations involve the integration of biomedical, behavioral, biostatistics, and health services/outcomes research and are reflected in a comprehensive training curriculum and research opportunities. Research innovations include novel methods of adherence assessment and intervention involving technology designed to enhance the engagement of children and adolescents, improve the power and duration of intervention effects, and reach diverse populations who cannot easily access traditional clinic- based approaches. Program innovation is also enhanced by novel research training opportunities to evaluate the comparative effectiveness of adherence promotion interventions in pediatric chronic illness management, to integrate objective methods of adherence measurement (e.g., behavioral, pharmacological, technological) and conduct advanced statistical analyses to evaluate the impact of adherence promotion interventions on children's health outcomes.
Graduates of this fellowship program will be national leaders who will have a significant scientific impact on research in pediatric treatment adherence and relevant health outcomes for many years to come. This program will result in effective interventions that will enhance adherence to medical treatment for children and adolescents with a wide range of pediatric conditions. These advances will reduce the extraordinary negative impact of pediatric nonadherence and enhance children's health by reducing symptoms, impairment, health care utilization, and costs of pediatric chronic illness treatment.
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