Assessment of Frailty Phenotype and Functional Limitations to Improve Prediction of Subsequent Health Care Utilization in Older Community-Dwelling Adults

评估虚弱表型和功能限制，以改善对社区老年人后续医疗保健利用的预测

• 批准号: 10024748
• 负责人: KRISTINE ENSRUD
• 金额: $ 49.39万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10024748
• 关键词: Accounting; Adult; Aging; Award; Behavioral; Biological; Body Composition; Body Weight decreased; Characteristics; Chronic; Clinical; Cohort Studies; Communities; Cost Measures; Cost Savings; Data; Databases; Demographic Accounting; Disease; Economics; Elderly; Enrollment; Evaluation; Fee-for-Service Plans; Funding; Future; Gait speed; Hand Strength; Health; Health Benefit; Health Care Costs; Health Expenditures; Health Insurance; Health care facility; Healthcare; Healthcare Systems; Hospitalization; Individual; Inpatients; Intervention; Intervention Trial; Link; Long-Term Care; Measures; Medical; Medicare; Medicare claim; Mission; Modeling; Outcome; Outpatients; Participant; Patient Self-Report; Patient risk; Patient-Centered Care; Patients; Persons; Phenotype; Prevalence; Primary Health Care; Process; Prospective cohort; Research; Risk; Risk Factors; Sampling; Variant; Woman; acute care; age related; aging population; base; cardiovascular health; care burden; care costs; clinical decision-making; clinical risk; cohort; cost; cost estimate; demographics; design; disability; epidemiology study; frailty; functional status; health care model; health care service utilization; high risk; improved; individual patient; instrumental activity of daily living; insurance claims; interest; men; multiple chronic conditions; older men; older women; osteoporosis with pathological fracture; outcome prediction; practice setting; prevent; social; therapy design; trend

Health care burden as manifested by greater health care utilization rises markedly with advancing age due in part to increasing prevalence of multiple chronic medical conditions (multimorbidity). While multimorbidity is a robust risk factor for higher health care burden, current multimorbidity measures explain only a modest proportion of the variation in subsequent health care costs. In order to constrain health care burden without negatively impacting health outcomes, improved understanding of key determinants of health care utilization among older adults is essential. Risk factors from other domains (including potentially modifiable determinants) would enhance identification of older community-dwelling adults likely to require costly care. Thus, models of health care utilization including the potentially modifiable (but not routinely measured in clinical settings) domains of the frailty phenotype and self-reported functional limitations may improve characterization of patient risk profiles and therefore improve targeting and design of interventions to reduce subsequent health care burden. The overarching objective of this proposal is to construct interpretable, generalizable and validated models of health care costs and utilization among older community dwelling adults that identify clinical risk factors amenable to targeted interventions to reduce risk of subsequent extensive and costly health care. We will take advantage of the linkage between community-dwelling participants in four cohort studies of older adults (Study of Osteoporotic Fractures [SOF]; Osteoporotic Fractures in Men Study [MrOS]; Health Aging and Body Composition Study [Health ABC]; and National Health and Aging Trends Study [NHATS]) and their Medicare claims data. We will perform a comprehensive evaluation of key potential clinical risk factors (frailty phenotype, self-reported functional limitations and components of frailty phenotype and functional limitations) for higher health care costs and utilization, after accounting for demographics and claims-based indicators of multimorbidity and frailty. Our application is consistent with the NIA mission to conduct biological, clinical, behavioral, social, and economic research related to the diseases and conditions associated with the aging process. Our study combines a wide range of data from four large epidemiologic studies leveraging the value of these cohorts in an efficient manner. If our hypotheses are confirmed, findings from our analyses will more accurately characterize subsets of older community-dwelling adults at risk for intense, costly health care; benefit health care systems/payers estimating costs vs. benefits of interventions aimed at delaying progression to frailty and disability; support assessment of the frailty phenotype, functional status, or specific individual components of these domains in the outpatient primary care practice setting; and direct the design of future targeted intervention trials aimed at reducing health care costs and utilization among the aged population.

由于更大的医疗保健利用率所表现出的医疗保健负担显着增加，随着年龄的增长 多种慢性医疗状况（多种病）的患病率增加的一部分。虽然多发生是一种 较高的医疗保健负担的强大危险因素，当前的多种多发性措施仅解释 随后的医疗保健费用的变化比例。为了限制医疗保健负担 对健康结果产生负面影响，对医疗保健利用的关键决定因素的理解有所提高 在老年人中，至关重要。来自其他领域的风险因素（包括潜在的可修改决定因素） 将增强对可能需要昂贵护理的较老的社区居民的识别。因此，模型 医疗保健利用包括可能修改的（但在临床环境中未经例行测量） 脆弱表型和自我报告的功能限制的域可能会改善患者的表征 风险概况，因此改善了干预措施的目标和设计，以减少随后的医疗保健 负担。该提案的总体目标是构建可解释，可推广和经过验证的 鉴定临床风险的老年社区成年人的医疗保健成本和利用模型 适合有针对性干预措施的因素，以减少随后的广泛和昂贵的医疗保健风险。我们 将利用四个老年研究中的社区居民参与者之间的联系 成年人（骨质疏松性裂缝[SOF]；男性骨质疏松性骨折研究[MROS]；健康衰老和 身体成分研究[Health ABC]；以及国家健康和衰老趋势研究[NHATS]）及其 Medicare声称数据。我们将对关键潜在临床风险因素进行全面评估（脆弱 表型，自我报告的功能局限性以及脆弱表型和功能限制的组成部分） 在考虑了人口统计和基于索赔的指标之后，要获得更高的医疗保健成本和利用 多种疾病和脆弱。我们的应用与NIA执行生物学，临床， 与衰老相关的疾病和状况有关的行为，社会和经济研究 过程。我们的研究结合了来自四个大型流行病学研究的广泛数据。 这些队列的有效方式。如果确认我们的假设，我们的分析发现将更多 准确地表征了老年社区居民的子集，面临着强烈，昂贵的医疗保健风险的危险； 利益医疗保健系统/付款人估计成本与旨在延迟进展的干预措施的收益 脆弱和残疾；支持评估脆弱的表型，功能状态或特定个人 在门诊初级保健实践设置中这些领域的组成部分；并指导未来的设计 针对性的干预试验旨在降低老年人口的医疗保健成本和利用。