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: 8150776
• 负责人: Lillian Chiang Min
• 金额: $ 8.55万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 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 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8150776
• 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）：许多一般预防和慢性疾病的临床指南已被证明可以改善选定的老年人群的健康结果。然而，目前尚不清楚针对患有多种慢性病的老年人遵守多项指南是否会带来与健康老年人相当的益处。还不清楚具体情况的护理、护理的协调还是一般预防措施应该具有最优先权。对复杂老年患者的护理质量和结果进行研究是朝着整体质量改进努力迈出的第一步。 评估弱势老年人护理 (ACOVE) 研究制定的基于证据和专家的指标涵盖一般/预防性医疗护理以及针对 15 种医疗和老年疾病的特定疾病护理。这些指标已用于通过 ACOVE-1 和 ACOVE-2 研究中 1000 多名患有 0 至 9 种慢性病的老年患者的详细医疗记录审查来收集护理质量和共病数据。这项拟议的研究首先旨在测试复杂（2-3 种共存慢性病）和高度复杂（e4 种疾病）老年人中较好的整体素质得分（通过遵守整套指标来衡量）是否与生存获益相关，即与更健康的老年人（0-1 条件）相当。第二个目标是测试是否可以根据生存效益优先考虑某些类型的护理（例如，一般/预防性护理与疾病治疗）。最后，该提案旨在对特定慢性病（例如糖尿病、高血压和痴呆症）的任何组合是否与较差的结果相关进行系统分析。为了分析这个研究问题，将从 ACOVE-2 队列中收集 3 年生存数据，并将其与原始 ACOVE-1 研究的现有 3 年生存数据进行汇总。 这项研究的结果将阐明是否应该根据患者的合并症水平来遵守指南，以达到更好的结果，以及是否可以优先考虑某些类型的护理。这些信息对于临床医生来说也非常宝贵，他们可以决定是否遵守针对患有多种疾病的老年患者的多种临床指南，此外还需要考虑患者的具体护理目标、偏好和预后。与公共卫生的相关性 接受更好质量的预防性护理（例如癌症筛查）和慢性病（例如高血压）的老年患者有更好的生存率。这项研究旨在探讨针对多种疾病采取推荐护理是否对患有多种慢性疾病（例如糖尿病、高血压和痴呆症）的老年人有同样的益处。医疗保健系统可以利用这些结果来优先考虑向老年患者推荐哪些指南，无论他们是健康的还是患有多种疾病的人。

项目成果

Rationalizing prescribing for older patients with multimorbidity: considering time to benefit.

合理化患有多种疾病的老年患者的处方：考虑受益时间。

• 发表时间: 2013-09
• 影响因子: 2.8
• 作者: Holmes, Holly M;Min, Lillian C;Yee, Michael;Varadhan, Ravi;Basran, Jenny;Dale, William;Boyd, Cynthia M
• 通讯作者: Boyd, Cynthia M