Enhanced data to accelerate complex patient comparative effectiveness research. A cardiovascular disease experiment - Cardiovascular disease (CVD) is the leading cause of death and over 80% of this is in people age 65, yet evidence-based guidelines are not aggressively followed, with the effect of co-morbidities not known. We will develop an easy to use data product for comparative effectiveness studies of 1.8 million Medicare heart attack and stroke patients and support its use through a collaboration between the lowa Older Adults Center for Education and Research on Therapeutics and the Institute for Clinical and Translational Science.

Should Utilization Rates High-Dose Statins for Complex Acute Myocardial Infarction (AMI) Patients Be Expanded? - Current US guidelines suggest that high risk complex patients with CVD receive high-dose statins, yet providers are not prescribing high-dose statins to most complex elderly CVD patients. Because the benefits and harms of high-dose statins appear heterogeneous across patients, insufficient evidence exists to assess whether current high-dose statin treatment rates represent over- or under-utilization for complex CVD patients. The results of this study will help clinicians, guideline-makers, and policy-makers understand the benefits, risks, and costs associated with high-dose statin treatments for complex CVD patients.

Comparative Effectiveness of Cardiovascular Treatment Combinations Post AMI in the Elderly - It is estimated that each year more than 610,000 Americans have new acute myocardial infarctions (AMIs) and 325,000 have a recurrent AMI. The results of this study will help clinicians, guideline-makers, and policy-makers understand the benefits, risks, and costs associated with post-MI secondary prevention treatment combinations.

Interpreting instrumental variables estimates when treatment effects are heterogeneous across patients: ACE/ARBs and Race - Assessing the comparative effectiveness of treatments in practice often requires analysis of observational healthcare databases. The properties of methods available to estimate comparative effectiveness from observational data are often unclear. The goal of this research is to provide clarity to healthcare policy-makers as to the treatment effect inferences that can be made from instrumental variable (IV) estimators.

IA-ADAPT: Improving Antipsychotic Appropriateness in Dementia - Cognitive impairment and dementia are major public health issues for the elderly and aging population, particularly nursing home residents. Behavioral problems in dementia place undue burden on caregivers, and current drug therapies for these problems are unsafe and have limited effectiveness. This research addresses AHRQ goals of assessing and improving the effectiveness of treatment strategies for dementia.

Comparative Effectiveness of FIT vs. Colonoscopy for Colon Cancer Screening - This study will provide critical information on the test characteristics of a fecal immunochemical test for colon cancer screening in an average risk U.S. population and individual's attitudes and preferences for these tests, which will help lay the foundation for a larger colorectal cancer screening trial to be conducted in our primary care practice-based rural research network, the Iowa Research Network. The larger, future trial will involve fecal immunochemical testing, followed by colonoscopy for those who are FIT positive, in a sample of average-risk individuals across the state of Iowa.