End-of-Life Trajectories: A Prospective Model

描述(申请人提供)：不断增长的预期寿命和现代医学的成功已经使晚年虚弱的状况变得越来越普遍，这是一个国家的医疗保健系统还没有完全适应的趋势。该项目旨在更好地了解健康和医疗保健需求的年龄概况，及其对残疾水平和医疗保险费用的影响。它将采用最近开发的寿命终结功能轨迹类型学，脆弱是其中的一种类型。到目前为止，几乎所有使用这一概念方案的实证工作都使用了回顾方法。为了进一步开发和应用这一概念方案，并调查其作为人口健康和护理成本领域的预测和规划工具的有用性，我们将开发一个寿命结束功能轨迹的前瞻性模型。我们将使用类型学作为一种方法，将结构强加给生命周期结束时被忽略或未区分的功能和服务使用模式中的异质性。我们的具体目标是(1)使用来自全国长期护理调查(NLTCS；1984-2004)的纵向数据，估计死亡率、伤残和医疗保险费用的综合模型，与1982-2004年的连续医疗保险索赔记录相关联；(2)在控制诊断和治疗的同时，对年龄和死亡时间对医疗费用的相对影响产生新的估计；(3)对选定的一组个人治疗历史(取自关联的NLTCS-联邦医疗保险索赔记录)进行深入审查，以验证和改进统计模型；以及(4)开发一个数据库和算法，用于根据估计的统计模型对队列残疾和医疗保险费用概况进行微观模拟预测。利用微观模拟框架，我们将进行几个“实验”，旨在揭示有关实质、方法、政策和实践的重要问题。与公共卫生的相关性：将要开发的预测模型将有助于更好地理解临终健康和医疗保健模式、残疾和医疗保险成本之间的关系。随着人们平均寿命的持续增长，服务使用模式、成本以及随着死亡临近而功能下降的经历都将发生变化，需要新的实践模式，并影响患者及其家人的生活。我们的模型旨在提高我们预测这些生命终结模式的能力。最后，活动预期寿命--人们可以预期生活在“活动”或健康状态的年数--已成为一个被广泛接受的公共健康指数，我们的模型将改进对这一指数的估计。

DESCRIPTION (provided by applicant): Growing life expectancy and the successes of modern medicine have made increasingly common a late-life condition of frailty, a trend to which the nation's health care system has not fully adapted. This project is intended to provide improved understanding of the age profile of health and health care needs, along with their implications for disability levels and Medicare costs. It will employ a recently developed typology of end- of-life functional trajectories, of which frailty is one type. Nearly all of the empirical work to date that employs this conceptual scheme has used retrospective methods. To further develop and apply this conceptual scheme, and to investigate its usefulness as a forecasting and planning tool in the area of population health and care costs, we will develop a prospective model of end-of-life functional trajectories. We will use the typology as a way of imposing a structure on what is otherwise ignored, or undifferentiated, heterogeneity in end-of-life functional and service-use patterns. Our specific aims are to (1) estimate an integrated model of mortality, disability, and Medicare costs, using longitudinal data from the National Long Term Care Survey (NLTCS; 1984-2004), linked to continuous Medicare claims records for 1982-2004; (2) produce new estimates of the relative effects of age and time to death on health care costs, while controlling for diagnoses and treatments; (3) conduct an intensive review of a selected set of individual treatment histories (taken from the linked NLTCS-Medicare claims records) in order to validate and refine the statistical model; and (4) develop a database and algorithms with which to conduct microsimulation forecasts of cohort disability and Medicare-cost profiles based on the estimated statistical model. Using the microsimulation framework, we will conduct several "experiments" intended to inform important issues of substance, method, policy and practice. Relevance to public health: The predictive model to be developed will lead to improved understanding of the relationships between end-of-life health and health care patterns, disability, and Medicare costs. As people's average lifetimes continue to grow, patterns of service use, costs, and experiences with declining function as death approaches will all change, requiring new practice patterns and affecting the lives of patients and their families. Our model is intended to improve our ability to predict these end-of-life patterns. Finally, Active Life Expectancy-the number of years people can expect to live in an "active" or healthy state-has become a widely-accepted index of public health, and our model will produce improved estimates of this index.