Investigation of Longitudinal Consequences of Adverse Events among Older Adults

老年人不良事件纵向后果的调查

基本信息

批准号：
7843540
负责人：
Mary W Carter
金额：
$ 14.87万
依托单位：
WEST VIRGINIA UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-05-15 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7843540
关键词：
Acute Address Adverse effects Adverse event Affect Attention Behavioral Caring Cessation of life Code Data Files Data Sources Dependency Elderly Environmental Risk Factor Event Foundations Future Goals Hazard Models Health Health Care Costs Health Status Healthcare Healthcare Systems Healthy People 2010 Hospitalization Hospitals Human Incidence Individual Injury Institute of Medicine (U.S.)Investigation Left Length of Stay Literature Long-Term Effects Measures Medical Medicare Methods Modeling Monitor Nursing Homes Outcome Pattern Physical Function Population Reporting Research Research Activity Risk Risk Factors Running Seminal Sentinel Services Surveys Techniques Time United States adverse outcome base beneficiary care episode cohort cost disability experience frailty functional status improved innovation insight mortality patient safety prevent public health relevance response

项目摘要

DESCRIPTION (provided by applicant): Despite concerted research efforts to understand causes and consequences of adverse medical events, sometimes referred to as medical injuries, a paucity of information exists about the scope and impact of adverse medical events over time, especially among older adults. Moreover, because previous research has focused primarily on acute care settings, little is known about the pattern of adverse medical events across healthcare settings. In response, the overall goal of this project is to conduct a nationally representative, longitudinal investigation of the incidence of adverse medical events among older adults and examine the subsequent patterns of health, healthcare service use, and costs over several years duration. To achieve our project goal, the following four, specific aims will guide research activities: (1) Examine the incidence and patterns of sentinel adverse medical events among older adults across settings and over time. (2) Examine the consequences of sentinel adverse medical events on subsequent healthcare service use over time. (3) Explore transitions in health and functioning levels over time. (4) Estimate the direct and indirect healthcare costs associated with sentinel adverse medical events over several years of study. We will draw upon multiple years of the Medicare Current Beneficiary Survey (MCBS), a nationally representative, longitudinal panel of Medicare beneficiaries, to build an analytical data file capable of tracking adverse medical events across medical settings and over time for five separate cohorts of Medicare beneficiaries. Descriptive and multivariate techniques will be used to explore longitudinal trajectories of health, functional status, service use and costs of older adults experiencing an adverse medical event. Hazard models will be estimated to explore the long-term effect of adverse medical events on the risk of nursing home entry, hospitalization or death. Multivariate transition models will be estimated to investigate the effect of adverse medical events on subsequent transitions between health status states and physical functioning levels over time. Findings from this research are expected to provide new insight into the scope and complexity of adverse medical events among older adults by adding to the existing literature in several innovative ways. First, we will extend previous research efforts in new directions by exploring both the direct and indirect impact of adverse medical events on outcomes over time. Second, we will develop a comprehensive approach to measuring both the incidence and impact of adverse medical events by creating windows of observation that extend beyond a single setting or medical episode. Third, our use of longitudinal methods will allow us to explore the extent to which individual, behavioral and environmental factors affect outcomes. And fourth, findings from our study will provide critical insight into the efficiency of the healthcare system by examining the burden of adverse medical events and providing a strong, empirical foundation to guide future studies. Public Health Relevance: This study will identify risk factors of and long-term consequences following adverse medical events among older adults. Findings will assist ongoing efforts to identify and prevent medical injuries. The study addresses the Institute of Medicine's To Err is Human objective to reduce medical injuries as well as the Healthy People 2010's objectives to improve patient safety and reduce injuries.

描述（由申请人提供）：尽管进行了一致的研究工作，以了解不良医疗事件的原因和后果，有时也称为医疗伤害，但由于随着时间的推移，尤其是在老年人中，不良医疗事件的范围和影响很少。此外，由于以前的研究主要集中在急性护理环境上，因此对整个医疗保健环境的不良医疗事件的模式知之甚少。作为回应，该项目的总体目标是对老年人不良医疗事件发生的发生率进行全国代表性的纵向调查，并检查随后的健康状况，医疗保健服务的使用和成本多年的持续时间。为了实现我们的项目目标，以下四个具体目标将指导研究活动：（1）检查跨环境和随着时间的时间的老年人中哨兵不良医疗事件的发生率和模式。（2）检查哨兵不良医疗事件对随后的医疗服务使用的后果。（3）随着时间的推移，探索健康和功能水平的过渡。（4）估计几年来研究中与哨兵不良医疗事件相关的直接和间接医疗费用。我们将借鉴多年来的Medicare当前受益人调查（MCB），这是一个全国代表的Medicare受益人纵向小组，以构建一个分析数据文件，能够在医疗环境中跟踪不良医疗事件，并且随着时间的流逝，五个单独的同伙人群。描述性和多元技术将用于探索健康，功能状况，服务使用和成本的纵向轨迹，发生了不良医疗事件。危害模型估计将探讨不良医疗事件对疗养院进入，住院或死亡风险的长期影响。将估计多元过渡模型，以研究不良医学事件对随着时间的变化状态和身体功能水平随后的过渡的影响。预计这项研究的结果将通过以几种创新的方式添加到现有文献中，从而为老年人不良医疗事件的范围和复杂性提供新的见解。首先，我们将通过探索不良医疗事件对随着时间的结果的直接和间接影响来扩展以前的研究工作。其次，我们将通过创建超越单个设置或医疗事件的观察窗口来开发一种全面的方法来衡量不良医疗事件的发生率和影响。第三，我们使用纵向方法将使我们能够探索个人，行为和环境因素影响结果的程度。第四，我们的研究结果将通过检查不良医疗事件的负担，并为指导未来的研究提供强大的经验基础，从而为医疗体系的效率提供批判性的见解。公共卫生相关性：这项研究将确定老年人不良医疗事件后的危险因素和长期后果。调查结果将有助于持续识别和防止医疗伤害的努力。该研究涉及医学研究所的错误是人类的目标，即减少医疗伤害以及健康人群2010年的目标，以提高患者安全并减少伤害。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Investigating the long-term consequences of adverse medical events among older adults.

调查老年人不良医疗事件的长期后果。

DOI：
10.1136/injuryprev-2013-041043
发表时间：
2014
期刊：
Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
影响因子：
0
作者：
Carter,MaryW;Zhu,Motao;Xiang,Jun;Porell,FrankW
通讯作者：
Porell,FrankW