Prioritizing Care of Complex Elders using Survival and Functional Status Outcomes

利用生存和功能状态结果优先照顾复杂的老年人

• 批准号: 7532880
• 负责人: Lillian Chiang Min
• 金额: $ 14.06万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7532880
• 关键词: Prioritizing; Care; Complex; Elders; using

DESCRIPTION (provided by applicant): Many clinical guidelines for general preventive and chronic diseases have been shown to improve health outcomes in selected populations of older adults. However, it is unclear whether adherence to multiple guidelines for elders with multiple chronic diseases will result in benefits that are comparable to healthier elders. It is also unclear whether care of specific conditions, coordination of care, or general preventive measures should have the most priority. Research on quality of care and outcomes among complex older patients is the first step towards targeting overall quality improvement efforts. The evidence- and expert-based indicators developed by the Assessing the Care of Vulnerable Elders (ACOVE) study cover general/preventive medical care plus disease-specific care for 15 medical and geriatric conditions. The indicators have been used to collect quality-of-care and co-morbidity data by detailed medical record review in the ACOVE-1 and ACOVE-2 studies for over 1000 older patients who had 0 to 9 co-existing chronic conditions. This proposed study first aims to test whether better overall quality scores (measured by adherence to the comprehensive set of indicators) among complex (2-3 co-existing chronic conditions) and highly complex (e4 conditions) elders are associated with survival benefit that is comparable to healthier elders (0-1 conditions). The second aim is to test whether certain types of care (e.g., general/preventive care versus treatment of conditions) can be prioritized according to survival benefit. Last, this proposal aims to perform a systematic analysis of whether any combinations of specific chronic conditions (e.g., having diabetes, hypertension, and dementia) are associated with poorer outcomes. To analyze this research question, 3-year survival data will be collected from the ACOVE-2 cohort and pooled with existing 3-year survival data from the original ACOVE-1 study. Results from this study will shed light on whether adherence to guidelines should be specific to a patients' level of co-morbidity based upon links to better outcomes, and whether certain types of care can be prioritized over others. Such information would also be invaluable to clinicians who make decisions whether or not to adhere to multiple clinical guidelines for their older patients with multiple morbidities, to consider in addition to their patients' specific goals of care, preferences, and prognoses. Relevance to Public Health Older patients who receive better quality of preventive care (e.g., cancer screening) and chronic diseases (e.g., high blood pressure) have better survival. This is a study to explore whether following recommended care for multiple conditions have the same benefit for elders who have many chronic diseases (e.g., diabetes, high blood pressure, and dementia). The results can be used by health care systems to prioritize which guidelines to recommend to their older patients whether they are healthy or are burdened by multiple conditions.

描述（由申请人提供）：已证明许多普通预防性和慢性疾病的临床指南可改善老年人选定人群的健康结果。但是，目前尚不清楚是否遵守多种慢性疾病的长者多种准则会导致与更健康的长者相媲美的益处。还不清楚对特定条件，护理协调或一般预防措施是否应具有最优先级。复杂老年患者的护理质量和成果的研究是针对整体质量改进工作的第一步。 评估弱势长者（ACOVE）研究的基于证据和专家的指标涵盖了15种医学和老年病情的一般/预防性医疗服务以及特定于疾病的护理。该指标已用于通过在ACOVE-1和ACOVE-2研究中为1000多名患有0至9个共存慢性病的老年患者进行详细的病历审查来收集护理质量和合并症数据。这项拟议的研究首先旨在测试复合物（2-3个共存的慢性病）和高度复杂（E4条件）长者之间更好的总体质量得分（通过遵守综合指标的遵守衡量）是否与生存益处相关，这与更健康的老人（0-1条件）相当。第二个目的是测试是否可以根据生存益处来优先考虑某些类型的护理（例如，一般/预防性护理与治疗状况的治疗）。最后，该提案旨在对特定慢性疾病（例如患有糖尿病，高血压和痴呆症）的任何组合进行系统分析。为了分析这一研究问题，将从ACOVE-2队列中收集3年生存数据，并与原始ACOVE-1研究中的现有3年生存数据合并。 这项研究的结果将阐明是否应根据与更好的结果的联系以及是否可以将某些类型的护理优先于其他类型的护理来确定与患者的合并症水平有关。对于临床医生而言，这些信息也将是无价的，这些临床医生是否遵守具有多种病因的老年患者的多个临床指南，除了患者的特定护理，偏好和预后外，还要考虑多个临床指南。与公共卫生的老年患者有关，他们获得更好的预防性护理质量（例如，癌症筛查）和慢性疾病（例如，高血压）具有更好的生存期。这是一项研究，旨在探讨针对多种疾病的建议护理是否对患有许多慢性疾病的长者（例如糖尿病，高血压和痴呆症）具有相同的好处。卫生保健系统可以使用该结果来优先考虑哪些指南向年长的患者推荐，无论他们是健康的还是受到多种状况的负担。