Trajectories and Palliation Study (TAPS)

描述(申请人提供)：越来越多的证据支持姑息治疗在改善患有晚期慢性严重疾病的患者和照顾者的护理效率和生活质量方面的作用。随着人口老龄化和严重慢性病的流行，以及对医疗支出的财政限制，改善获得和使用姑息治疗的机会变得更加重要。兰德健康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)，以评估医疗创新对医疗利用率和医疗成本以及患者和照顾者结果的影响。兰德使用有限元软件评估了人口结构变化、生活方式选择、新技术和其他趋势对CMS的未来影响。我们建议使用联邦医疗保险当前受益人调查(MCBS)和健康和退休调查(HRS)的数据来评估严重慢性病的轨迹，以表征患者及其照顾者随着时间的推移的功能、疼痛和情绪健康状况，比较前瞻性和回溯性方法，并对癌症、器官衰竭和脆弱轨迹进行狭义和宽泛的分类。我们将评估一系列与这些轨迹的关键变化相关的患者特征和医疗事件，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先前在2004年NIH生命末期护理科学会议上进行的广泛的文献综述，以综合关于姑息服务有效性的文献，包括 临终关怀在改善生活质量、利用率和成本结果方面的作用。根据文献，一个专家小组将评估实施姑息治疗的政策情景的可行性和有效性，以解决姑息治疗服务的时机、设置和组成。最后，根据我们对轨迹的经验检查、文献综述和专家小组的评级，我们将使用有限元分析来考虑实施姑息治疗服务的最高优先级政策情景对患者、照顾者以及医疗保险利用率和成本的影响。我们的团队密切合作，就临终关怀和临终关怀的政策相关方面进行研究，团队成员拥有丰富的政策制定、实施和评估经验，以改善晚期严重慢性病的护理。我们在拟议项目的方法方面拥有丰富的专业知识，包括定量分析、文献综合、适当性小组方法和政策传播。该项目不仅将为政策提供信息，而且还将确定在理解轨迹和姑息治疗有效性方面的关键差距，以便为研究重点提供信息。

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.