Trajectories and Palliation Study (TAPS)

描述（由申请人提供）：越来越多的证据支持姑息治疗在提高晚期慢性严重疾病患者和护理人员的护理效率和生活质量方面的作用。随着人口老龄化和晚期慢性疾病的流行，以及医疗保健支出的财政限制，改善姑息治疗的获取和使用变得越来越重要。兰德健康公司为医疗保险和医疗补助服务中心（CMS）开发了未来老年人模型（FEM），以评估医疗保健创新对护理的利用和成本以及患者和护理人员结果的影响。兰德公司使用FEM来评估人口变化、生活方式选择、新技术和其他趋势对CMS的未来影响。我们建议使用来自医疗保险当前受益人调查（MCBS）和健康与退休调查（HRS）的数据来评估严重慢性疾病的轨迹，以表征患者及其护理人员的功能，疼痛，情绪健康随时间的变化，比较前瞻性和回顾性方法，以及癌症，器官衰竭和虚弱轨迹的狭义和广义分类。我们将评估与这些轨迹的关键变化相关的一系列患者特征和医疗保健事件，以确定实施姑息治疗的可能触发因素。我们将更新和扩展我们之前在2004年为美国国立卫生研究院临终关怀科学会议进行的广泛文献综述，以综合有关姑息治疗有效性的文献，包括

DESCRIPTION (provided by applicant): Evidence increasingly supports the role of palliative care in improving both the efficiency of care and the quality of life of patients and caregivers living with advanced chronic serious illness. Improving access to and use of palliative care is becoming more important with our aging population and prevalence of advanced chronic illness, as well as fiscal constraints on healthcare spending. RAND Health developed the Future Elderly Model (FEM) for the Center for Medicare and Medicaid Services (CMS) to evaluate the impact of healthcare innovations on the utilization and cost of care, as well as patient and caregiver outcomes. RAND has used FEM to evaluate the future impact of changing demographics, lifestyle choices, novel technologies, and other trends for CMS. We propose to evaluate trajectories of serious chronic illness using data from the Medicare Current Beneficiary Survey (MCBS) and the Health and Retirement Survey (HRS) to characterize function, pain, emotional wellbeing over time among patients and their caregivers, comparing both prospective and retrospective approaches, and narrow and broad categorizations of cancer, organ failure, and frailty trajectories. We will evaluate a range of patient characteristics and healthcare events tha are associated with critical changes in those trajectories, in order to characterize possible triggers for implementing palliative care. We will update and expand extensive literature reviews we previously conducted for the NIH State of the Science Meeting on End of Life Care in 2004 in order to synthesize the literature on the effectiveness of palliative services including hospice in improving QOL, utilization, and cost outcomes. Informed by the literature, an expert panel will then rate the feasibility and validity of policy scenarios to implement palliative care hat address the timing, setting, and composition of palliative care services. Finally, informed by our empiric examination of trajectories, a synthesis of the literature, and ratings of the panel, we wil use the FEM to consider the impact of the highest priority policy scenarios to implement palliative care services on patients, caregivers, and Medicare utilization and cost. Our team has worked closely together conducting research on policy-relevant aspects of palliative and end of life care, and members of our team have extensive policy experience developing, implementing, and evaluating policies to improve the care of advanced serious chronic illness. We have tremendous expertise in the methods of the proposed project including quantitative analyses, literature syntheses, appropriateness panel methodologies, and policy dissemination. This project will not only inform policy, but also identify critical gaps in the understanding of trajectories and the effectiveness of palliative care to inform research priorities.