Improving integration of treatment burden information in primary care for older adults with multiple chronic conditions

Beth Israel Deaconess Medical Center, Boston MA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Over two-thirds of older adults in the US are diagnosed with multiple chronic conditions (MCCs). Due to the increased complexity of their care, these adults are at higher risk of experiencing treatment burden, defined as the patient-perceived effort of accommodating health care into one’s life, including cognitive load, time, and cost. Guidelines currently recommend reducing treatment burden as a part of the care of older adults with MCCs, yet no evidence-based approach exists to support this goal. Existing validated methods for assessing treatment burden, such as the Treatment Burden Questionnaire (TBQ), are lengthy and require information not routinely collected in clinical care (i.e. inaccessible in electronic health records or claims data), making them difficult to automate and implement in primary care settings where most older adults receive care. There is a critical need for a scalable, systematic approach to evaluate and respond to treatment burden, tailored to older adults with MCCs. The objective of this proposal is to establish a foundation for the integration of treatment burden information in primary care for older adults with MCCs. Mentored by an outstanding team of experts in aging research, I will: 1) Develop a scalable model to estimate TBQ treatment burden scores in older adults with MCCs, using data from the nationally- representative 2022 Health and Retirement Study TBQ linked with Medicare claims data, and 2) Conduct qualitative interviews with primary care providers (n=10), their patients aged ≥65 with MCCs (n=10), and caregivers of their patients aged ≥65 with MCCs (n=10) to understand key perspectives on experiences with assessing, managing, and communicating about treatment burden in primary care for older adults with MCCs. These aims will be undertaken in conjunction with career development activities focused on 1) prediction modeling using large observational data, 2) qualitative methods, and 3) research for older adults with MCCs. This proposal will advance our understanding of strategies to estimate treatment burden and to incorporate this information into primary care decision-making for older adults with MCCs, and inform future work developing strategies to reduce treatment burden for older adults with MCCs. It will also provide critical research skills and data to support progress towards my long-term goal of becoming an independent investigator reducing treatment burden and improving quality of life for older adults with MCCs.