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疾病的临床指南已被证明可以改善选定老年人人群的健康结果。然而，目前还不清楚是否坚持多种指南的老年人与多种慢性病将导致的好处是可比的健康的老年人。也不清楚具体情况的护理、护理协调或一般预防措施是否应具有最优先地位。对复杂老年患者的护理质量和结果的研究是朝着全面质量改进努力的第一步。 评估弱势老年人护理研究制定的基于证据和专家的指标涵盖一般/预防性医疗护理以及针对15种医疗和老年病的特定疾病护理。在ACOVE-1和ACOVE-2研究中，通过详细的病历审查，使用这些指标收集了1000多名患有0至9种并存慢性疾病的老年患者的护理质量和合并症数据。这项拟议的研究首先旨在测试复杂（2-3个共存的慢性病）和高度复杂（e4条件）的老年人之间更好的整体质量评分（通过遵守一套综合指标来衡量）是否与健康老年人（0-1条件）的生存益处相关。第二个目的是测试某些类型的护理（例如，一般/预防性护理相对于治疗病症）可以根据生存益处优先考虑。最后，该提案旨在对特定慢性疾病的任何组合（例如，患有糖尿病、高血压和痴呆症）与较差的结果相关。为了分析该研究问题，将从ACOVE-2队列中收集3年生存数据，并与原始ACOVE-1研究的现有3年生存数据合并。 这项研究的结果将阐明是否应根据与更好结局的联系，针对患者的合并症水平遵守指南，以及是否可以优先考虑某些类型的护理。这些信息对于临床医生也是非常宝贵的，他们决定是否要遵守针对患有多种疾病的老年患者的多个临床指南，以考虑除了他们的患者的护理、偏好和治疗的特定目标之外。与公共卫生的相关性接受更好质量的预防性护理的老年患者（例如，癌症筛查）和慢性疾病（例如，高血压患者的生存率更高。这是一项研究，旨在探讨以下针对多种疾病的推荐护理是否对患有多种慢性疾病（例如，糖尿病、高血压和痴呆）。医疗保健系统可以使用这些结果来优先考虑向老年患者推荐哪些指南，无论他们是健康的还是受到多种疾病的困扰。

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.