Multimorbidity Among People with Serious mental illness (MAPS): Mapping disease clusters, risk factors, trajectories, service barriers and outcomes

许多长期疾病对健康、医疗保健使用和费用以及预期寿命的影响在一般人群中是众所周知的，这种“多重疾病”的负担被认为是导致健康状况较差的原因。然而，人们对精神和身体上的多种长期状况如何影响严重精神疾病（SMI）患者知之甚少。尽管存在公认的“死亡率差距”，与一般人群相比，患有SMI的人往往在更年轻的时候死亡。这意味着了解不同的疾病组合或疾病“集群”（例如心脏病或呼吸系统疾病）如何影响SMI患者，了解谁可能因这种“疾病负担”而面临最大风险以及如何支持他们至关重要。在这项工作计划中，我们将汇集大型数据集，这些数据集涵盖了重度精神障碍患者健康和疾病的许多方面，以确定重度精神障碍患者的长期状况集群，确定促成这些分组的风险因素，并了解它们对健康和疾病以及无家可归等更广泛问题的影响。这项工作的目标是帮助开发更好的提供护理的方法，并缩小死亡率差距。通过与服务用户，卫生专业人员和政策制定者合作，我们将确定如何将我们对这些“集群”的理解转化为改善服务的行动，带来更好的护理，并帮助减少疾病的风险和负担。为了做到这一点，我们将1）总结和检查关于这一主题的所有现有证据，以帮助我们提出潜在的疾病分组，患病率和结果。然后，我们将2）使用SMI患者的医疗记录来了解这些患者如何使用医疗保健，他们所属的疾病分组，以及某些风险因素是否对某些人的影响比其他人更大，并随着时间的推移跟踪人们，以了解谁更容易住院或死亡。我们还将3）与SMI患者进行访谈，以更深入地了解他们对医疗保健系统的使用，他们与NHS的经验，他们如何随着时间的推移获得长期条件，生活在多种健康状况下的经验，他们的生活状况如何影响他们的健康以及他们需要什么帮助。最后，我们将联合收割机结合所有的研究结果，以确定这些疾病分组对患者和服务的意义，并找到改善NHS为这些分组中的患者提供护理的方法。这将包括改善护理途径，既帮助“集群”内的现有服务用户，又帮助规划通过加强预防减少最终患多种疾病的人数的方法。在整个工作方案中，服务使用者将在开展研究、帮助解释和传播研究结果以及共同制定改善护理的解决方案方面发挥不可或缺的作用。它将为NHS医疗保健专业人员提供信息，通过更好地了解谁是风险最大的人，帮助预防SMI患者中多种长期疾病的发展。它将帮助NHS了解如何通过认识到不同的“集群”有不同的需求来改善对患有许多长期疾病的SMI患者的护理。这项工作的核心目标是改善SMI患者的生活，通过提高对该群体多重疾病负担的理解，并确定减轻负担的方法，支持患有复杂疾病组合的人，并帮助人们活得更长，更健康。

The impact of having many long-term conditions on health, use of health care and costs, and life expectancy is well understood in the general population, where this burden of "multimorbidity" is recognised as leading to poorer health outcomes. However, far less is known about how having multiple long-term conditions, both mental and physical, affects people with serious mental illness (SMI). This is despite there being a recognised 'mortality gap', where people with SMI tend to die at younger ages compared to the general population. This means it is vital to understand how having different combinations, or 'clusters' of illnesses for example cardiac diseases or respiratory diseases, might affect people with SMI, to understand who may be most at risk due to this 'disease burden' and how they can be supported. In this programme of work, we will bring together large data sets that capture many aspects of health and illness for people with SMI, to identify clusters of long-term conditions among people with SMI, identify the risk factors that contribute to these groupings, and understand their impacts on both health and illness, as well as on broader problems such as homelessness. The goal of this work is to help develop improved ways of delivering care and decrease the mortality gap. By working with service users, health professionals and policy makers, we will identify how our understanding of these 'clusters' can be translated into actions that improve service, lead to better care, and help reduce the risk and burden of illness. To do this, we will 1) summarise and examine all existing evidence on this topic to help us come up with potential disease groupings, prevalence and outcomes. We will then 2) use health care records from people with SMI to understand how these patients use health care, the disease groupings they belong to, and whether certain risk factors affect some people more than others, as well as follow people over time to understand who is more at risk of being hospitalised or dying. We will also 3) hold interviews with people with SMI to understand in more depth their use of the health care system, their experiences with the NHS, how they acquired their long-term conditions over time, the experience of living with multiple health conditions, how their living situation affects their health and what help they would have needed. Finally, we will 4) combine all the findings to agree what these disease groupings mean for patients and services and find ways to improve how the NHS delivers care for patients in these groupings. This will include improving care pathways that both help existing service users within the 'clusters' and help to plan ways to reduce the number of people who end up with multiple illnesses, through enhanced prevention. Throughout the programme of work, service users will play an integral role in developing the research, helping to interpret and disseminate findings and co-producing solutions for improved care.This research will have an impact on many levels. It will provide NHS health care professionals with information to help prevent the development of multiple long-term conditions among people with SMI, by better understanding who is most at risk. It will help the NHS understand how to improve the care of people with SMI who have many long-term conditions, by recognising how different 'clusters' have different needs. The core goal of this work is to improve the lives of people with SMI, by improving understanding of the burden of multimorbidity for this group and identifying ways to decrease that burden, support people living with complex combinations of illness, and help people live longer and healthier lives.