Predicting Care Coordination Needs of Frail Older Adults from Longitudinal Data

从纵向数据预测体弱老年人的护理协调需求

• 批准号: 8093217
• 负责人: Tae Youn Kim
• 金额: $ 8.68万
• 依托单位: UNIVERSITY OF WISCONSIN MILWAUKEE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8093217
• 关键词: Administrator; Adult; Affect; Boxing; Care given by nurses; Caring; Characteristics; Chronic Disease; Chronically Ill; Clinical; Clinical Trials; Communication; Communities; Complex; Computerized Patient Records; Data; Data Set; Databases; Decision Making; Decision Support Systems; Devices; Effectiveness; Elderly; Enrollment; Event; Frail Elderly; Frail Older Adults; Health; Health Care Costs; Health Services; Health Status; Healthcare; Healthcare Systems; Home Health Care Agencies; Home environment; Information Systems; Intervention; Knowledge; Life; Measures; Mediator of activation protein; Medicare claim; Medication Management; Methods; Modeling; Natural Language Processing; Nurses; Outcome; Outcome Measure; Patients; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Process; Provider; Randomized Controlled Trials; Research; Research Personnel; Resources; Services; Statutes and Laws; Structure; System; Systems Development; Testing; Text; Time; cost; design; health care quality; improved; innovation; insight; meetings; patient home care; payment; predictive modeling; programs; satisfaction; service utilization; treatment as usual

DESCRIPTION (provided by applicant): The current health care system fails to meet the needs of most chronically ill older adults. Given that the chronically ill are the major consumers of health care dollars, development of systems that provide support in the management of the complex health care needs is critical. Care coordination is one intervention that is recognized as a mechanism to support chronically ill persons in managing their health care. However, care coordination has multiple definitions, models, providers, and settings. Most care coordination programs have been focused on specific time periods such as transition between care settings. Further, there is limited evidence about the key components of care coordination, making the content of care coordination virtually a "black box" although payment for care coordination is included in current health care legislation. Accordingly, the purpose of this proposed study is to examine the type and amount of nurse care coordination interventions and the relationship of these interventions to both patient characteristics and outcomes. To be specific, this study aims to " identify interventions used in nurse care coordination for frail older community dwelling adults; " identify the relationships among patient characteristics, components of nurse care coordination intervention, and patient outcomes; and " develop and validate models predicting patient outcomes for frail older community dwelling adults who received nurse care coordination interventions. This proposed study employs a secondary analysis that will examine existing datasets derived from a recent randomized controlled trial that tested the effectiveness of a home care medication management program (HCMM) for frail older adults. The datasets examined will include electronic patient records and communication logs documented through the CareFacts(R) system, HCMM Access database, and Medicare claims data. Due to the complexity of datasets with structured data and unstructured narrative text data, both natural language processing and statistical analyses will be employed according to the purpose of the study. This project is innovative in that it explores nurse care coordination interventions that followed patients across multiple settings with the focus on management of their chronic illness care in their day to day life over a one year period in the home setting. The results of this study will add new insight to the relationships among specific patient characteristics, care coordination interventions, and patient outcomes. This new knowledge will assist decision-making of clinicians, health administrators, and policy makers with respect to health care quality, resource utilization, cost reduction, and reimbursement policy. Also, the resulting predictive model will assist in clinical information system design to support clinicians' decision-making. PUBLIC HEALTH RELEVANCE: This proposed study will use existing data to examine the type and amount of nurse care coordination interventions provided to frail older community dwelling adults. The results of this study will add new insight to the relationships among specific patient characteristics, nurse care coordination interventions, and patient outcomes. This new knowledge also will assist decision-making of clinicians, health administrators, and policy makers with respect to health care quality, resource utilization, cost reduction, and reimbursement policy. Finally, findings can be used to inform health care consumers about nurse care coordination for frail older adults living in the community.

描述（由申请人提供）：当前的医疗保健系统无法满足大多数长期病重的老年人的需求。鉴于慢性病是医疗保健金钱的主要消费者，因此开发在复杂医疗保健需求的管理方面提供支持的系统至关重要。护理协调是一种干预措施，被认为是支持长期病人管理医疗保健的一种机制。但是，护理协调有多个定义，模型，提供商和设置。大多数护理协调计划都集中在特定时间段内，例如护理环境之间的过渡。此外，关于护理协调的关键组成部分的证据有限，这使得医疗协调的内容实际上是“黑匣子”，尽管当前的医疗保健立法中包括用于护理协调的付款。因此，这项拟议的研究的目的是检查护士护理协调干预的类型和数量以及这些干预措施与患者特征和结果的关系。具体来说，本研究的目的是“确定用于脆弱的老年社区成年人护士护理协调的干预措施；”确定患者特征，护士护理协调干预的组成部分和患者结果之间的关系；并开发和验证模型，预测了接受护士护理协调干预措施的脆弱的老年社区居住的成年人。这项拟议的研究采用了二次分析，将检查次要分析，该分析将研究从最近的随机对照试验中得出的现有数据集，该试验测试了对家庭护理药物管理计划（HCMM）的有效性（通过较脆弱的老年人的培训）。 HCMM访问数据库和Medicare索赔数据，由于数据集的结构性数据和非结构化的叙事文本数据的复杂性，自然语言处理和统计分析将根据该项目的目的而进行，因为该项目是创新的。这项研究的结果将为特定患者特征，护理协调干预和患者预后之间的关系增添新的见解。这些新知识将有助于临床医生，卫生管理人员和政策制定者的决策，方面，有关卫生保健质量，资源利用，降低成本和报销政策。此外，由此产生的预测模型将有助于临床信息系统设计，以支持临床医生的决策。 公共卫生相关性：这项拟议的研究将使用现有数据来检查提供给脆弱的老年社区住宅成年人提供的护士护理协调干预措施的类型和数量。这项研究的结果将为特定患者特征，护理护理协调干预和患者预后之间的关系增添新的见解。这些新知识还将协助临床医生，卫生管理员和政策制定者在医疗保健质量，资源利用，降低成本和报销政策方面的决策。最后，发现可用于告知医疗保健消费者有关居住在社区中的脆弱老年人的护理护理协调。