Prioritizing Care of Complex Elders using Survival and Functional Status Outcomes

描述(由申请人提供)：许多一般预防和慢性病的临床指南已被证明可以改善选定的老年人群体的健康结果。然而，目前尚不清楚为患有多种慢性病的老年人遵守多种指南是否会产生与更健康的老年人相当的好处。也不清楚具体情况的护理、护理的协调还是一般的预防措施应该是最优先的。对复杂老年患者的护理质量和结果进行研究是朝着全面质量改进努力的目标迈出的第一步。 评估易受伤害老年人护理研究制定的循证和专家指标涵盖一般/预防性医疗护理以及针对15种医疗和老年疾病的具体疾病护理。在ACOVE-1和ACOVE-2研究中，通过详细的病历审查，这些指标已被用于收集护理质量和共同发病率数据，这些研究针对1000多名同时患有0至9种慢性病的老年患者。这项拟议的研究首先旨在测试复杂(2-3种并存的慢性病)和高度复杂的(e4种病症)老年人中较好的整体质量分数(通过遵守一套综合指标来衡量)是否与可与更健康的老年人(0-1病症)相媲美的生存福利相关。第二个目标是测试某些类型的护理(例如，一般/预防性护理与疾病的治疗)是否可以根据生存福利优先考虑。最后，这项建议旨在对特定慢性病(例如，患有糖尿病、高血压和痴呆症)的任何组合是否与较差的结果相关进行系统分析。为了分析这一研究问题，将从ACOVE-2队列中收集3年生存率数据，并与原始ACOVE-1研究中现有的3年生存率数据合并在一起。 这项研究的结果将阐明遵守指南是否应该针对患者的共病水平，基于与更好的结果的联系，以及是否可以将某些类型的护理优先于其他类型。这样的信息对于临床医生来说也是非常有价值的，他们决定是否遵守患有多种疾病的老年患者的多种临床指南，除了考虑患者的具体护理目标、偏好和预后外。与公共卫生的相关性接受更高质量的预防性护理(例如癌症筛查)和慢性病(例如高血压)的老年患者的存活率更高。这是一项研究，旨在探索以下针对多种疾病的推荐护理是否对患有多种慢性病(例如糖尿病、高血压和痴呆症)的老年人具有相同的好处。医疗保健系统可以使用这些结果来优先向他们的老年患者推荐哪些指南，无论他们是健康的还是有多种疾病负担的。

DESCRIPTION (provided by applicant): Many clinical guidelines for general preventive and chronic diseases have been shown to improve health outcomes in selected populations of older adults. However, it is unclear whether adherence to multiple guidelines for elders with multiple chronic diseases will result in benefits that are comparable to healthier elders. It is also unclear whether care of specific conditions, coordination of care, or general preventive measures should have the most priority. Research on quality of care and outcomes among complex older patients is the first step towards targeting overall quality improvement efforts. The evidence- and expert-based indicators developed by the Assessing the Care of Vulnerable Elders (ACOVE) study cover general/preventive medical care plus disease-specific care for 15 medical and geriatric conditions. The indicators have been used to collect quality-of-care and co-morbidity data by detailed medical record review in the ACOVE-1 and ACOVE-2 studies for over 1000 older patients who had 0 to 9 co-existing chronic conditions. This proposed study first aims to test whether better overall quality scores (measured by adherence to the comprehensive set of indicators) among complex (2-3 co-existing chronic conditions) and highly complex (e4 conditions) elders are associated with survival benefit that is comparable to healthier elders (0-1 conditions). The second aim is to test whether certain types of care (e.g., general/preventive care versus treatment of conditions) can be prioritized according to survival benefit. Last, this proposal aims to perform a systematic analysis of whether any combinations of specific chronic conditions (e.g., having diabetes, hypertension, and dementia) are associated with poorer outcomes. To analyze this research question, 3-year survival data will be collected from the ACOVE-2 cohort and pooled with existing 3-year survival data from the original ACOVE-1 study. Results from this study will shed light on whether adherence to guidelines should be specific to a patients' level of co-morbidity based upon links to better outcomes, and whether certain types of care can be prioritized over others. Such information would also be invaluable to clinicians who make decisions whether or not to adhere to multiple clinical guidelines for their older patients with multiple morbidities, to consider in addition to their patients' specific goals of care, preferences, and prognoses. Relevance to Public Health Older patients who receive better quality of preventive care (e.g., cancer screening) and chronic diseases (e.g., high blood pressure) have better survival. This is a study to explore whether following recommended care for multiple conditions have the same benefit for elders who have many chronic diseases (e.g., diabetes, high blood pressure, and dementia). The results can be used by health care systems to prioritize which guidelines to recommend to their older patients whether they are healthy or are burdened by multiple conditions.