Promoting health and preventing disease in disadvantaged urban neighborhoods

项目摘要 此应用程序响应SIP13-072，扩展有关痴呆症和共生疾病的信息 老年人的慢性病，将为临床医生、政策制定者和 研究人员建立/完善指导方针和有针对性的干预措施，以提高老年人的护理质量 患有认知障碍(CI)和多种慢性病(MCC)。它将解决在以下方面的主要研究差距 先前通过SIP10-037和其他潜在的优先领域确定的公共卫生实践信息 疾控中心国家慢性病预防与健康中心的健康老龄化计划， 人口健康司，即“多种慢性病”、“提供临床预防措施” 服务“和”服务利用结果--住院“。 第一部分包括对综合健康和退休研究/医疗保险的二次分析 用于衡量CI和MCC对必要和预防性接收的影响的管理数据数据库 护理和门诊护理敏感的住院治疗。它将解决早期研究的几个具体限制 关于CI和MCC患者对卫生服务的使用情况：重点关注过度使用或使用不足，而不是护理质量； 关注单一的慢性疾病，而不是MCC；简单化的概念化和可操作性 MCC；没有检查NPC对其他服务利用率的影响；无法检查CI水平。 构成部分二包括利用专家小组指导的文献审查和公共政策议程 发展战略建议与选定的健康老龄化研究网络中心合作 在CI、生物行为心脏健康(B2H2)合作、国际 多发病研究社区和疾病预防控制中心项目科学家。 第一部分的目标是：在具有全国代表性的65岁及以上成年人样本中： 目标1：提供基线描述性统计数据，并确保目标2和目标3遵循SMART原则， 测量CI和MCC的发生和共存情况：一年期间CI的患病率(无，轻度， 中度/重度)和慢性疾病，使用计数、公布的指数、共病交集、 老年综合征和身体残疾，以及经验性地衍生的共病集群；目标2：在交叉试验中 横断面分析，比较鼻咽癌和H-ACS在患有和不患有MCC的个体中的使用(测量如下 和/或轻度或中度/重度CI；目标3：测试模型以检查是否收到 鼻咽癌不足在MCC和/或CI与H-ACS发生可能性的关系中起中介作用。 第二部分目标 目标1：进行指导性文献回顾，以更新SIP10-037中有关知识差距的发现 关于老年人的MCC；目标2：集合并聘请一个5-8人的专家小组来开发、审查和 为健康老龄化研究网络传播公共卫生议程。

PROJECT ABSTRACT This application in response to SIP13-072, Expanding Information about Dementia and Co-occurring Chronic Conditions among Older Adults, will provide critical information to clinicians, policy makers and researchers to establish/refine guidelines and target interventions to improve quality of care for older adults with cognitive impairment (CI) and multiple chronic conditions (MCC). It will address major research gaps in public health practice information previously identified through SIP 10-037 and other potential priority areas of the Healthy Aging Program in the CDC's National Center for Chronic Disease Prevention and Health Program, Division of Population Health, viz., "multiple chronic conditions", "provision of clinical preventive services" and "service utilization outcomes-hospitalizations." Component One consists of a secondary analysis of the combined Health and Retirement Study/Medicare administrative data database to measure the impact of CI and MCC on receipt of necessary and preventive care and ambulatory-care-sensitive hospitalizations. It will address several specific limitations of earlier studies on health services use by persons with CI and MCC: focus on over- or under-use rather than quality of care; focus on single chronic conditions rather than MCC; simplistic conceptualization and operationalization of MCC; failure to examine the impact of NPC on other service utilization; and inability to examine level of CI. Component Two consists of the use of an expert-panel guided literature review and public policy agenda development strategy proposing collaboration with selected Healthy Aging Research Network Centers having particular expertise in/focus on CI, the BioBehavioral Heart Health (B2H2) Collaboration, the International Research Community on Multimorbidity, and CDC Project Scientists. Component One Aims: In a nationally representative sample of adults age 65 and older: Aim 1: To provide baseline descriptive statistics and ensure that Aims 2 and 3 follow SMART principles, measure the occurrence and co-occurrence of CI and MCC as: one-year period prevalence of CI (none, mild, moderate/severe) and chronic conditions using counts, published indices, intersection of comorbidities, geriatric syndromes and physical disability, and empirically derived clusters of comorbidities; Aim 2: In a cross- sectional analysis, compare the use of NPC and H-ACS in individuals with and without MCC (measured as indicated above) and/or with mild or moderate/severe CI; Aim 3: Test a model to examine whether receipt of inadequate NPC mediates the relationship between MCC and/or CI and higher likelihood of H-ACS. Component Two Aims Aim 1: Conduct a guided literature review to update findings from SIP 10-037 regarding gaps in knowledge about MCC in older adults; Aim 2: Assemble and engage a 5-8 member expert panel to develop, vet and disseminate a public health agenda for the Healthy Aging Research Network.