Improving Care for Older Adults with Serious Illness

改善对患有严重疾病的老年人的护理

基本信息

批准号：
8529434
负责人：
AMY STEVES KELLEY
金额：
$ 15.71万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8529434
关键词：
Accounting Address Admission activity Aging Area Atlases Automobile Driving Award Back Beds Caregivers Caring Characteristics Clinical Cohort Studies Communities Data Decision Making Development Development Plans Educational Curriculum Elderly Expenditure Family Future Geographic Locations Goals Health Health Policy Health Services Research Healthcare Hospital Costs Hospitalization Hospitals Individual Intervention Interview Knowledge Lead Leadership Learning Life Longevity Measures Medical Medicare Medicare claim Mentors Methods Modeling Outcome Patient Preferences Patient-Centered Care Patients Pattern Physicians Policies Population Primary Care Physician Quality of life Research Research Design Research Personnel Research Training Resources Retirement Risk Risk Factors Selection Bias Services Specialist Techniques Translating Treatment Cost Work base beneficiary career development cohort cost design experience functional decline hospital admission rate improved innovation mortality novel novel strategies patient oriented patient population preference programs prospective research and development satisfaction socioeconomics therapy development

项目摘要

DESCRIPTION (provided by applicant): This proposal represents a five-year curriculum and research plan designed to facilitate my development to an independent investigator in patient-oriented aging research. During the five years of the award, I will expand on my health services research training and experience through mentored research, formal coursework, and selfdirected learning activities and develop independence through leadership and networking opportunities. The current pace of U.S. healthcare spending is unsustainable as the oldest segments of the population expand. Hospital services account for the largest portion of Medicare costs, the bulk of which goes to a specific patient population: older adults with serious illness. Geographic regions vary widely in their intensity of hospital use and some argue this represents discretionary or unnecessary hospital-based care. Increased spending is also not associated with higher quality, as measured by longevity, quality of life, and satisfaction. Understanding what factors contribute to unnecessary hospitalizations among at-risk older adults is essential for development of successful new models of efficient, patient-centered care. Thus, the goal of my research is to prospectively identify seriously ill older adults at risk of hih-cost hospital-based care, and identify "triggers" of potentially avoidable hospitalizations and barriers to remaining in the community for these patients. Specifically, I plan to: (SA1) Build upon my prior work by examining determinants of hospital expenditures, number of hospital admissions and high-intensity, hospital-based treatment in the last year of life among the Health and Retirement Study (HRS) cohort using a mortality follow-back design; (SA2) Expand my earlier findings by evaluating factors associated with hospital expenditures, number of hospitalizations and treatment intensity among a cohort of seriously ill older adults matched prospectively by 1-year mortality risk; and (SA3) Support the development of an intervention to reduce unnecessary hospital admissions among at-risk older adults by investigating reasons for multiple hospital admissions and barriers to management outside the hospital among seriously ill older adults by conducting qualitative interviews with patients, caregivers and primary care physicians. The proposed work uses an innovative combination of regional, patient-level and claims data to evaluate factors driving treatment intensity in this population; examines outcomes with both a traditional mortality follow-back study design and a novel prospective analytic technique; and employs mixed methods to learn from patients and families what problems lead to excess hospitalizations and how those challenges might be overcome. Through my current work and future independent research, I plan to create a patient-centered intervention to reduce unnecessary hospitalizations among seriously ill older adults and translate my work to effective health care policies and clinical programs. The proposed research and career development plan are important initial steps toward advancing the care of older adults by improving medical decision making in the face of serious illness and promoting policies that better align treatments with patient preferences.

描述（由申请人提供）：该提案代表了一项五年的课程和研究计划，旨在促进我向以患者为导向的衰老研究的独立研究者的发展。在奖项的五年中，我将通过指导的研究，正式课程以及自我指导的学习活动来扩展我的健康服务研究培训和经验，并通过领导和网络机会发展独立性。随着人口最古老的人口扩大，美国医疗保健支出的目前速度是不可持续的。医院服务占医疗保险费用的最大部分，其中大部分涉及特定的患者人群：患有严重疾病的老年人。地理区域的医院使用强度差异很大，有些人认为这代表了酌情或不必要的医院护理。通过长寿，生活质量和满意度来衡量的支出也与更高质量无关。了解哪些因素导致高危老年人不必要的住院，这对于开发成功的以患者为中心的新模型的发展至关重要。因此，我的研究的目的是前瞻性地确定患有HIH成本医院护理风险的重病老年人，并确定可能避免的住院和障碍的“触发器”，以使这些患者留在社区中。具体而言，我计划：（SA1）在我先前的工作基础上检查医院支出的决定因素，医院入院的数量和高强度，医院基于医院的治疗，在健康和退休研究的最后一年（HRS）群体中，使用死亡率使用死亡率遵循背包设计；（SA2）通过评估与医院支出相关的因素，住院数量和治疗强度相关的因素，在一系列重病老年人中与1年死亡率相匹配；（SA3）支持开发一项干预措施，以调查多次医院入院的原因，并通过对患者，护理人员和初级保健医生进行定性访谈，以减少高危老年人的不必要的住院。拟议中的工作使用区域，患者级别的创新组合和声称数据来评估驱动该人群治疗强度的因素；通过传统的死亡率跟随研究设计和一种新颖的前瞻性分析技术来检查结果。并采用混合方法向患者和家庭学习哪些问题导致过度住院以及如何克服这些挑战。通过我目前的工作和未来的独立研究，我计划创建以患者为中心的干预措施，以减少重病老年人的不必要住院，并将我的工作转化为有效的医疗保健政策和临床计划。拟议的研究和职业发展计划是通过在严重疾病的情况下改善医疗决策和促进政策，以更好地使治疗与患者的偏好保持一致的政策，这是促进老年人护理的重要初步步骤。