Universal outcomes as a common metric across multiple diseases in elders

普遍结果作为老年人多种疾病的通用指标

• 批准号: 7914152
• 负责人: MARY E TINETTI
• 金额: $ 16.79万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-15 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7914152
• 关键词: Accounting; Activities of Daily Living; Address; Aging; Arthritis; Cardiovascular system; Cessation of life; Chronic Disease; Chronic Obstructive Airway Disease; Chronic lung disease; Conflict (Psychology); Data; Decision Making; Dementia; Diagnosis; Diagnostic; Disease; Elderly; Equilibrium; Face; Future; Goals; Health; Health Policy; Heart failure; Impairment; Individual; Investigation; Maps; Measurable Disease; Mediating; Metric; Morbidity - disease rate; Outcome; Policy Research; Prevention; Preventive; Research; Symptoms; Testing; Therapeutic; Therapeutic Intervention; Time; Women' s Health; clinical decision-making; cognitive function; cohort; cost; experience; health care service utilization; instrumental activity of daily living; mortality; patient oriented; psychologic; public health relevance; quality assurance; social

DESCRIPTION (provided by applicant): Multiple morbidity complicates clinical decision-making and health policy. The prevention, diagnosis, and treatment of multiple diseases are burdensome, expensive, and potentially contradictory or harmful. Treating one disease may make other(s) worse. Furthermore, individuals with multiple diseases have varying health outcome priorities. Resolving these challenges and conflicts is difficult without a common metric to compare, contrast, and/or combine across diseases. The goal of this line of investigation, beginning with this exploratory study, will be to provide evidence supporting universal health outcomes as the unifying focus and common metric across chronic diseases. The purpose of this exploratory study is to determine whether disease-specific outcomes represent intermediates outcomes that mediate the effect of individual diseases on universal health outcomes. The primary aim is to determine, for individual chronic diseases, whether and to what extent disease-specific outcomes represent intermediate outcomes between the disease and one or more universal health outcomes. We will test the hypothesis that >50% of the effect of each of 4 diseases on one or more universal outcomes is mediated through the disease-specific outcomes. The secondary aim is to determine, for the combination of coexisting diseases, whether and to what extent disease-specific outcomes mediate the effect of the combination of coexisting diseases on universal health outcomes (this aim extends the primary aim by considering all 4 diseases together). We will address these aims in two longitudinal cohorts of older adults, the Women's Health and Aging Study I and ll and Cardiovascular Health Study. The chronic diseases include: heart failure, dementia, chronic lung disease, and arthritis. The universal outcome domains include: 1) Basic, instrumental, and social- productive activities of daily living; 2) psychological functioning; 3) cognitive functioning; 4) symptom and impairment burden; and 5) survival /death. Finding that disease-specific outcomes map unto a universal set of health outcomes would support universal health outcomes as a common metric across diseases. If verified in future definitive studies, results of this line of investigation could ultimately inform clinical decision-making, research, and health policy. PUBLIC HEALTH RELEVANCE: The prevention, diagnosis, and treatment of multiple diseases are burdensome, expensive, and potentially contradictory or harmful. Resolving these challenges and conflicts is difficult without a common metric to compare, contrast, and/or combine across diseases. If disease-specific outcomes map unto a universal set of health outcomes, then these universal health outcomes could serve as common metrics across diseases that could inform clinical decision-making, research, quality assurance, and health policy.

描述（由申请人提供）：多重发病率使临床决策和健康政策复杂化。多种疾病的预防，诊断和治疗是繁重的，昂贵的，并且可能矛盾或有害。治疗一种疾病可能会使另一种疾病恶化。此外，患有多种疾病的人的健康结果重点不同。如果没有通用指标，就很难解决这些挑战和冲突，可以比较，对比和/或跨疾病。从这项探索性研究开始，这种调查的目的是提供支持普遍健康结果的证据，作为统一的重点和跨慢性疾病的普通指标。这项探索性研究的目的是确定疾病特异性结果是否代表了中间的结果，可以介导个人疾病对普遍健康结果的影响。主要目的是确定个体慢性疾病，无论疾病特定的结果是否代表疾病与一种或多种普遍健康结果之间的中间结果。我们将测试以下假设：4种疾病中每种疾病对一种或多种普遍结果的影响的50％是通过疾病特异性结果介导的。第二个目的是确定共存疾病的结合，是否以及在何种程度上介导了疾病特异性的结果介导共存疾病对普遍健康结果的影响（此目的通过考虑所有4种疾病一起考虑了主要目的）。我们将在两个老年人的纵向人群中解决这些目标，即女性健康和衰老研究I和LL和心血管健康研究。慢性疾病包括：心力衰竭，痴呆，慢性肺部疾病和关节炎。普遍的结果领域包括：1）日常生活的基本，工具和社会生产活动； 2）心理功能； 3）认知功能； 4）症状和障碍负担； 5）生存 /死亡。发现特定疾病的结果映射到一系列普遍的健康结果将支持普遍的健康结果，这是跨疾病的常见指标。如果在未来的确定研究中得到验证，则此调查的结果最终可能会为临床决策，研究和卫生政策提供依据。公共卫生相关性：多种疾病的预防，诊断和治疗是繁重的，昂贵的且可能矛盾或有害的。如果没有通用指标，就很难解决这些挑战和冲突，可以比较，对比和/或跨疾病。如果特定于疾病的结果映射到一系列普遍的健康状况，那么这些普遍的健康结果可以作为跨疾病的常见指标，这些指标可以为临床决策，研究，质量保证和健康政策提供依据。