End-of-Life Trajectories: A Prospective Model

描述（由申请人提供）：预期寿命的增长和现代医学的成功使得晚年虚弱的状况越来越普遍，而国家的卫生保健系统还没有完全适应这一趋势。该项目旨在更好地了解健康和保健需求的年龄分布，以及它们对残疾水平和医疗保险费用的影响。它将采用最近开发的生命末期功能轨迹类型，其中虚弱是一种类型。迄今为止，几乎所有采用这一概念方案的实证工作都使用了回顾性方法。为了进一步发展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预测和规划工具的实用性，我们将开发一个生命末期功能轨迹的前瞻性模型。我们将使用类型学作为一种将结构强加于在生命周期结束的功能和服务使用模式中被忽略或未区分的异质性上的方式。我们的具体目标是：(1)利用国家长期护理调查（NLTCS; 1984-2004）的纵向数据，与1982-2004年的连续医疗保险索赔记录相关联，估计死亡率、残疾和医疗保险成本的综合模型；(2)在控制诊断和治疗的同时，对年龄和死亡时间对医疗保健费用的相对影响作出新的估计；(3)对选定的一组个人治疗史（从相关的NLTCS-Medicare索赔记录中提取）进行深入审查，以验证和完善统计模型；(4)开发数据库和算法，根据估计的统计模型对队列残疾和医疗保险成本概况进行微观模拟预测。使用微观模拟框架，我们将进行几个“实验”，旨在告知物质，方法，政策和实践的重要问题。与公共卫生的相关性：有待开发的预测模型将使人们更好地了解临终健康与卫生保健模式、残疾和医疗保险费用之间的关系。随着人们的平均寿命持续增长，随着死亡的临近，服务使用模式、成本和功能下降的经验都将发生变化，需要新的实践模式，并影响患者及其家属的生活。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，积极预期寿命——人们可以预期在“积极”或健康状态下生活的年数——已经成为一个被广泛接受的公共健康指数，我们的模型将产生对该指数的改进估计。

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.