Creating a better index for measuring multimorbidity in older adults

创建更好的指数来衡量老年人的多重发病率

• 批准号: 9172986
• 负责人: MICHAEL A. STEINMAN
• 金额: $ 40.23万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9172986
• 关键词: Activities of Daily Living; Address; Aging; Bathing; Caring; Categories; Cessation of life; Characteristics; Clinical; Clinical Research; Cohort Studies; Communities; Comorbidity Index; Consult; Data; Data Sources; Degenerative polyarthritis; Disease; Disease Marker; Elderly; Ensure; Epidemiologic Studies; Foundations; Health; Health Services Research; Health system; Healthcare; Hospitalization; Intervention; Life; Life Experience; Link; Measurable; Measures; Medicare claim; Methods; Modeling; Observational Study; Outcome; Patient Self-Report; Patient-Focused Outcomes; Patients; Population; Process; Quality of life; Research; Research Personnel; Retirement; Severity of illness; Sum; Syndrome; Techniques; Work; base; burden of illness; clinical care; clinical epidemiology; cohort; daily functioning; flexibility; functional decline; functional outcomes; functional status; health data; high risk; improved; indexing; innovation; instrumental activity of daily living; interest; meetings; model development; mortality; multiple chronic conditions; novel; patient oriented; predictive modeling; programs; public health relevance; self-reported functional status; sound; tool; trend

Background: The presence of multiple chronic conditions (multimorbidity) has profound impacts on the health and health care of older adults. As a result, epidemiologic and clinical research on older adults depends on being able to measure multimorbidity in an accurate and conceptually valid manner. Yet, existing methods of measuring multimorbidity have critical gaps. Most existing measures that use commonly-available data sources include only diseases that predict hospitalization and death. These methods are ill-suited to measure other aspects of multimorbidity, including its impact on older adults' ability to function independently in daily life – an outcome of vital importance to this population. The large and growing body of research and clinical programs that focus on functional outcomes thus lack the proper tools to address multimorbidity. Innovative uses of claims data hold great promise to develop new measures of multimorbidity focused on its impact on functional outcomes. Moreover, these approaches offer a unique opportunity to improve upon existing multimorbidity measures that focus on “traditional” outcomes such as hospitalization and death. Aims: (1) To develop and validate claims-based measures of multimorbidity that predict decline in ability to perform basic and instrumental activities of daily living (ADLs, IADLs); (2) Using an expanded range of disease characteristics measurable in claims data, to develop and validate measures of multimorbidity that predict hospitalization and death; (3) To compare the predictive validity of our measures for functional decline, hospitalization, and death with existing measures of multimorbidity such as the Charlson Index. Methods: Using Medicare claims data linked to self-report ADL and IADL data from the Health and Retirement Study, we will build 4 indices of multimorbidity using the framework of prognostic model development. Each index will be developed to predict a separate outcome related to multimorbidity, including decline in ability to perform ADLs (e.g. bathing), decline in ability to perform IADLs (e.g. shopping), hospitalization, and death. Predictors in these models will be disease characteristics that can be measured in claims data including diseases, markers of disease severity, and disease-disease interactions. These prognostic models will be converted into simple indices, where each disease characteristic will be assigned a number of points, and the sum of these points will give a patient-level multimorbidity score. We will internally validate our indices using bootstrapping techniques, and externally validate them in a cohort of older adults from the National Health and Aging Trends Study. Throughout this process, we will consult with a group of expert advisors to ensure that we develop our measures in a manner that is maximally useful to researchers and health systems leaders. Relevance / public health significance: Improved measures of multimorbidity that reflect patient-centered outcomes will be crucial tools for clinical epidemiology, health services research, and clinical programs that seek to improve care for older adults.

背景：多种慢性病的存在（多种疾病）对健康有深远的影响 和老年人的医疗保健。结果，关于老年人的流行病学和临床研究取决于 能够以准确且概念上有效的方式衡量多发性。但是，现有的方法 测量多种病的差距很大。大多数使用常用数据的现有措施 来源仅包括预测住院和死亡的疾病。这些方法不适合测量 多种多发性的其他方面，包括其对老年人在日常生活中独立运作能力的影响 - 对这个人群至关重要的结果。大量的研究和临床 因此，专注于功能结果的程序缺乏解决多种疾病的适当工具。创新的 索赔数据数据具有巨大的希望，可以制定针对其对其对影响的影响的新措施 功能结果。此外，这些方法为改进现有的独特机会提供了独特的机会 多发性措施旨在关注“传统”结果，例如住院和死亡。 目的：（1）开发和验证基于索赔的多种多发性措施，以预测能力下降的能力下降 进行日常生活的基本和乐器活动（ADLS，IADLS）； （2）使用扩大的疾病范围 在索赔数据中可测量的特征，以开发和验证多发症的措施预测 住院和死亡； （3）比较我们的测量值对功能下降的预测有效性， 住院和死亡，现有的多种措施，例如查尔森指数。 方法：使用与健康和退休的自我报告ADL和IADL数据相关的Medicare索赔数据 研究，我们将使用预后模型开发的框架来构建4个多物种指数。每个 将开发索引以预测与多种多发病有关的单独结果，包括能力下降 执行ADL（例如洗澡），执行IADL（例如购物），住院和死亡的能力下降。 这些模型中的预测因素将是可以在索赔数据中衡量的疾病特征 疾病，疾病严重程度的标志和疾病疾病相互作用。这些预后模型将是 转换为简单指数，每个疾病特征将被分配多个点，然后 这些点的总和将给出患者级的多发性评分。我们将在内部使用 引导技术，并在国家卫生中的一群老年人中对其进行验证 衰老趋势研究。通过此过程，我们将咨询一组专家顾问，以确保我们 以对研究人员和卫生系统领导者最大程度有用的方式制定我们的措施。 相关性 /公共卫生的意义：改进的多种措施反映了以患者为中心的 成果将是临床流行病学，卫生服务研究和临床计划的关键工具 寻求改善对老年人的护理。