Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making

应用基于索赔的衰弱指数为衰弱指导决策提供证据

基本信息

批准号：
10297953
负责人：
Dae Hyun Kim
金额：
$ 65.19万
依托单位：
HEBREW REHABILITATION CENTER FOR AGED
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10297953
关键词：
Acupuncture Therapy Acute Address Adverse event Affect Analgesics Boston COVID-19 Cardiac Surgery procedures Cardiovascular Agents Cardiovascular Diseases Caring Categories Cessation of life Chronic Chronic Obstructive Airway Disease Chronic low back pain Clinical Clinical Trials Clinical assessments Communities Data Decision Making Delirium Dementia Diabetes Mellitus Drug Prescriptions Effectiveness Elderly Electronic Health Record Funding Goals Health Health Care Costs Health Services Research Health Status Health system Healthcare Systems Heart failure Hip Fractures Home Hospitalization Hospitals Institutionalization Intensive Care Units Investigation Link Massachusetts Measurement Measures Medicare Methods Mission Modeling National Institute on Aging Operative Surgical Procedures Osteoporosis Outcome Outcomes Research Participant Patient-Centered Care Patients Peripheral arterial disease Persons Pharmaceutical Preparations Pharmacoepidemiology Pharmacotherapy Pneumonia Population Pragmatic clinical trial Provider Public Health Randomized Controlled Trials Research Research Personnel Resources Sampling Skilled Nursing Facilities System Testing Time United States National Institutes of Health Variant Ventilator Work acute care base clinical care clinical practice clinically actionable comorbidity comparative effectiveness study cost critical limb Ischemia disability evidence base experience frailty health management improved indexing innovation medication safety personalized care population health pragmatic trial predictive modeling programs risk prediction risk stratification routine care safety study treatment as usual treatment effect venous thromboembolism

项目摘要

PROJECT SUMMARY/ABSTRACT Older adults with frailty are more likely to experience poor health outcomes after acute illnesses, drug-related adverse events, and surgeries. Health care costs for frail patients double due to acute hospital care, post-acute care, and treatments for preventable conditions. Despite clinical and societal consequences of frailty, frailty is rarely assessed in clinical practice and little evidence exists on how to integrate frailty to inform clinical care and population health management. The critical step to generate this evidence is to measure frailty on a large scale with high accuracy and efficiency. To address this need, the investigator team recently developed and validated a claims-based frailty index (CFI), which enables measurement of frailty from Medicare data for large populations when in-person assessment is not feasible. The objective of this application is to generate evidence needed for frailty-guided clinical care and population health management by applying CFI to claims data-based studies of drug therapy; pragmatic clinical trials of procedural therapy; and electronic health records (EHR)-Medicare linked data of a health care system. The central hypothesis is that frailty information will improve care of older adults by uncovering meaningful variations in the treatment benefit-harm profile, costs, and resource needs. To test this hypothesis, the investigator team with extensive expertise in frailty, pharmacoepidemiologic methods, and health services research will accomplish the following specific aims in the next 5 years: 1) determine how frailty changes the benefits and harms of 10 prescription drugs for chronic conditions in older adults by applying CFI to the 2014-2022 5% Medicare random sample; 2) determine how frailty changes the benefits and harms of procedural therapies in older adults by applying CFI to Medicare data linked to 2 ongoing pragmatic clinical trials of endovascular vs surgical revascularization therapy for peripheral arterial disease and acupuncture vs usual care for chronic low back pain; and 3) determine whether implementing CFI to EHR-Medicare linked data can predict high-cost and high-need patients in a large health care system in Boston, Massachusetts. The innovative applications of CFI are readily scalable to claims-based comparative effectiveness and safety studies, clinical trials, and EHR in health care systems. The impact of this research is significant because the clinically actionable evidence generated from this research can enable optimal choice of drug and procedural therapy and a health system-wide risk stratification based on frailty. Ultimately, these results will accelerate integration of frailty in routine care and facilitate frailty-guided clinical care and population health management.

项目摘要/摘要脆弱的老年人更有可能在急性疾病后患有不良健康结果不良事件和手术。由于急性医院护理，急性后，脆弱患者的医疗保健费用会增加一倍护理和治疗可预防条件。尽管脆弱的临床和社会后果，但脆弱是在临床实践中很少评估，几乎没有证据表明如何整合脆弱的临床护理和人口健康管理。产生这一证据的关键步骤是大规模测量脆弱具有高精度和效率。为了满足这一需求，调查员团队最近开发并验证了基于索赔的脆弱指数（CFI），可以从医疗保险数据中衡量大量人群的脆弱性当面对面评估不可行时。此应用的目的是为需要的证据通过将CFI应用于基于数据的研究，药物治疗；程序治疗的务实临床试验；和电子健康记录（EHR）-Medicare链接医疗保健系统的数据。中心假设是脆弱的信息将改善对老年人的护理通过发现治疗福利障碍概况，成本和资源需求的有意义的变化。测试这个假设，研究人员团队具有丰富的专业知识，药物电子学方法和卫生服务研究将在未来5年内实现以下特定目标：1）确定脆弱性通过应用CFI改变老年人的慢性病的10种处方药的益处和危害到2014-2022 5％Medicare随机样品； 2）确定脆弱如何改变通过将CFI应用于与2个正在进行的务实临床试验相关的Medicare数据中，老年人的程序疗法用于周围动脉疾病和针灸的血管内与手术血运重建疗法照顾慢性下背部疼痛； 3）确定将CFI实施到EHR-Medicare链接数据是否可以在马萨诸塞州波士顿的大型医疗保健系统中预测高成本和高需求的患者。创新 CFI的应用很容易可扩展到基于索赔的比较有效性和安全性研究，临床试验和卫生保健系统中的EHR。这项研究的影响很大，因为临床上可行这项研究产生的证据可以实现最佳的药物和程序治疗以及健康基于脆弱的系统范围的风险分层。最终，这些结果将加速脆弱的整合常规护理并促进脆弱的临床护理和人口健康管理。