Development and Validation of 10-Year Life Expectancy Calculators to Individualize Veterans’ Prevention Decisions

开发和验证 10 年预期寿命计算器，以实现退伍军人的个性化预防决策

• 批准号: 10308527
• 负责人: Sei Lee
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308527
• 关键词: Activities of Daily Living; Address; Age; Blood Pressure; Blood Vessels; Breast Cancer Detection; Caring; Characteristics; Chronic; Clinic; Clinical; Clinical Data; Colorectal; Colorectal Cancer; Data; Decision Making; Dementia; Development; Diagnosis; Diagnostic tests; Discrimination; Disseminated Malignant Neoplasm; Distress; Elderly; Electronic Health Record; Foundations; Frail Elderly; Future; Goals; Gold; Guidelines; Harm Reduction; Healthcare Systems; Hypoglycemia; Individual; Intervention; Laboratories; Lead; Learning; Life Expectancy; Link; Malignant Neoplasms; Measurement; Measures; Medical center; Medicare; Modeling; Needs Assessment; PSA screening; Patients; Performance; Pharmacy facility; Predictive Value; Prevention; Primary Health Care; Provider; Records; Research; Risk; Risk Factors; Screening for cancer; Sensitivity and Specificity; Statistical sensitivity; Symptoms; System; Testing; Time; Validation; Veterans; Work; base; clinical decision-making; cohort; colorectal cancer screening; comorbidity; demographics; diabetic; electronic data; falls; functional status; glycemic control; improved; indexing; individualized prevention; instrumental activity of daily living; mortality; mortality risk; point of care; preventive intervention; screening; statistics; tool

Ignoring life expectancy can lead to poor clinical decisions. Healthy older adults who could benefit from screening have low screening rates. Older adults with dementia or metastatic cancer are screened for slow- growing cancers that are unlikely to cause symptoms but may lead to distress from false-positive results, invasive work-ups and treatments. Life expectancy calculators offer the possibility of moving beyond arbitrary age-based cutoffs to more rational life expectancy based decision-making, incorporating age as well as other factors known to predict mortality such as comorbidities, demographics, laboratory results and pharmacy data. The objectives of the study are to (a) develop and validate a 10-year life expectancy calculator using 2005 VA electronic data (demographics, comorbidities, laboratory results and pharmacy records); (b) develop and validate an Augmented life expectancy calculator that adds 2009 functional assessments (Activities of Daily Living or ADL and Instrumental Activities of Daily Living or IADL assessments) to the other risk factors and determine whether the addition of ADL and IADL data lead to improved discrimination; ); (c) develop and validate a VA-Medicare life expectancy calculator that adds 2009 Medicare data to the other risk factors and determine whether the addition of Medicare data lead to improved discrimination; (d) apply the life expectancy calculator to a national VA cohort to determine the proportion of colorectal cancer (CRC) screening that occurs in veterans with limited life expectancy (<25% likelihood of life expectancy of 10+ years) and extended life expectancy (>75% likelihood of life expectancy of 10+ years) in both veterans within the recommended age (50-75) for CRC screening as well as veterans at more advanced age (76-85) when screening is not routinely recommended. By developing and validating a VA electronic data driven life expectancy calculator, this project will determine the rates of potentially inappropriate CRC overscreening in age-appropriate veterans (age 50-75) with a limited life expectancy (<25% likelihood of life expectancy 10+ years). Conversely, this project will also identify potentially inappropriate CRC underscreening in veterans beyond the recommend age for screening (age 76-85) with an extended life expectancy (>75% likelihood of life expectancy of 10+ years). This work will provide the critical foundation for an intervention to improve the targeting of CRC screening will estimate an individual veterans' life expectancy to 1) suppress CRC screening clinical reminders for patients with limited life expectancy (age 50-75) or 2) trigger CRC screening clinical reminders for patients with extended life expectancy (age 76-85). Further, accurate life expectancy estimates could also be utilized to individualize other prevention decisions that have a long time to benefit, such as breast cancer screening and intensive glycemic control. Thus, this work would be another way that the VA would become a Learning Healthcare System that uses clinical data to individualize veterans' prevention decisions and inform system-wide decisions regarding prevention clinical alerts.

忽略预期寿命会导致临床决策不良。健康的老年人，可以从中受益 筛选率较低。筛查痴呆症或转移性癌症的老年人，以缓慢 种植不太可能引起症状但可能导致假阳性结果的癌症的癌症， 侵入性的工作和治疗。预期寿命计算器提供了超越任意的可能性 基于年龄的基于年龄的截止 已知可以预测死亡率的因素，例如合并症，人口统计，实验室结果和药房数据。 该研究的目标是（a）使用和验证使用10年的预期寿命计算器 2005 VA电子数据（人口统计学，合并症，实验室结果和药房记录）； （b）发展 并验证增强的预期寿命计算器，该计算器添加了2009年功能评估（活动的活动 日常生活或ADL以及日常生活或IADL评估的工具活动） 并确定添加ADL和IADL数据是否会导致歧视的改善； ）； （c）发展和 验证va-Medicare寿命计算器，该计算器将2009年的Medicare数据添加到其他风险因素和 确定添加Medicare数据是否导致歧视改善； （d）应用预期寿命 计算器到国家VA队列以确定发生的结直肠癌比例（CRC）筛查的比例 在预期寿命有限的退伍军人中（预期寿命为10多年）并延长寿命 预期（> 75％的预期寿命为10多年）在推荐年龄段之内 （50-75）用于CRC筛查以及更高年龄的退伍军人（76-85），当时不常规筛查 受到推崇的。 通过开发和验证VA电子数据驱动的预期寿命计算器，该项目将 确定与年龄相适应的退伍军人（50-75岁）中潜在不适当CRC过度筛分的速度 预期寿命有限（<25％的预期寿命10多年）。相反，这个项目也将 确定超出推荐年龄的退伍军人的潜在不适当的CRC下调 （76-85岁）预期寿命延长（> 75％的预期寿命为10年以上）。这项工作将 为改善CRC筛查的靶向靶向的干预提供了关键的基础，将估计 个人退伍军人的预期寿命为1）抑制生命有限的患者的CRC筛查临床提醒 预期（50-75岁）或2）触发寿命延长的患者的CRC筛查临床提醒 预期（76-85岁）。此外，还可以利用准确的预期寿命估计来个性化 其他有很长一段时间的预防决策，例如乳腺癌筛查和强化 血糖控制。因此，这项工作将是VA成为学习医疗保健的另一种方式 使用临床数据来个性化退伍军人的预防决策并为全系统决策提供信息的系统 关于预防临床警报。

项目成果

Making Function Part of the Conversation: Clinician Perspectives on Measuring Functional Status in Primary Care.

让功能成为对话的一部分：临床医生对初级保健功能状态测量的看法。

• DOI: 10.1111/jgs.15677
• 发表时间: 2019
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Nicosia,FrancescaM;Spar,MalenaJ;Steinman,MichaelA;Lee,SeiJ;Brown,RebeccaT
• 通讯作者: Brown,RebeccaT

Exploring the Dynamics of Week-to-Week Blood Pressure in Nursing Home Residents Before Death.

探索疗养院居民生前每周血压的动态。

• DOI: 10.1093/ajh/hpab142
• 发表时间: 2022
• 期刊: American journal of hypertension
• 影响因子: 3.2
• 作者: Graham,LauraA;Lee,SeiJ;Steinman,MichaelA;Peralta,CarmenA;Rubinsky,AnnaD;Jing,Bocheng;Fung,KathyZ;Odden,MichelleC
• 通讯作者: Odden,MichelleC

Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.

• DOI: 10.1111/jgs.17735
• 发表时间: 2022-07
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Lederle, Lauren, I;Steinman, Michael A.;Jing, Bocheng;Nguyen, Brian;Lee, Sei J.
• 通讯作者: Lee, Sei J.

Sliding scale insulin use in a national cohort study of nursing home residents with type 2 diabetes.

• DOI: 10.1111/jgs.17771
• 发表时间: 2022-07
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Lam, Kenneth;Gan, Siqi;Nguyen, Brian;Jing, Bocheng;Lee, Sei J.
• 通讯作者: Lee, Sei J.

Frailty and mortality: 'Same-same but Different'.

虚弱和死亡：“相同但不同”。

• DOI: 10.1136/bmjqs-2018-008821
• 发表时间: 2019
• 期刊: BMJ quality & safety
• 影响因子: 5.4
• 作者: Lee,SeiJ