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.

项目概要/摘要身体虚弱的老年人在患上与药物有关的急性疾病后，更容易出现健康状况不佳的情况不良事件和手术。由于急性住院护理、急性后护理，体弱患者的医疗费用增加了一倍可预防疾病的护理和治疗。尽管虚弱会产生临床和社会后果，但虚弱是很少在临床实践中进行评估，也很少有证据表明如何将虚弱纳入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性具有高精度和高效率。为了满足这一需求，研究团队最近开发并验证了基于索赔的虚弱指数 (CFI)，可以根据大量人群的医疗保险数据来衡量虚弱程度当亲自评估不可行时。该应用程序的目的是生成所需的证据通过将 CFI 应用于基于索赔数据的研究，以虚弱为指导的临床护理和人口健康管理药物治疗；程序性治疗的实用临床试验；和电子健康记录 (EHR)-医疗保险相关医疗保健系统的数据。中心假设是衰弱信息将改善老年人的护理通过揭示治疗利害关系、成本和资源需求方面的有意义的变化。测试对于这一假设，研究团队在虚弱、药物流行病学方法和方法方面拥有丰富的专业知识卫生服务研究将在未来 5 年内实现以下具体目标： 1) 确定脆弱性如何通过应用 CFI 改变 10 种处方药治疗老年人慢性病的益处和危害 2014-2022 年 5% 医疗保险随机样本； 2）确定虚弱如何改变其益处和危害通过将 CFI 应用于与 2 项正在进行的实用临床试验相关的医疗保险数据，对老年人进行程序性治疗外周动脉疾病的血管内血运重建治疗与手术血运重建治疗以及针灸与常规治疗的比较护理慢性腰痛； 3) 确定对 EHR-Medicare 链接数据实施 CFI 是否可以预测马萨诸塞州波士顿大型医疗保健系统中的高费用和高需求患者。创新的 CFI 的应用很容易扩展到基于声明的比较有效性和安全性研究、临床试验以及医疗保健系统中的 EHR。这项研究的影响是重大的，因为临床上可行这项研究产生的证据可以实现药物和程序治疗的最佳选择以及健康基于脆弱性的全系统风险分层。最终，这些结果将加速脆弱性的整合常规护理并促进虚弱指导的临床护理和人口健康管理。