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Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making

应用基于索赔的衰弱指数为衰弱指导决策提供证据

基本信息

批准号：
10640938
负责人：
Dae Hyun Kim
金额：
$ 56.33万
依托单位：
HEBREW REHABILITATION CENTER FOR AGED
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10640938
关键词：
Acceleration Acupuncture Therapy Acute Address Adverse event Affect Analgesics Boston COVID-19 Cardiac Surgery procedures Cardiovascular Agents Cardiovascular Diseases Caring Categories Cessation of life Chronic Chronic Obstructive Pulmonary Disease Chronic low back pain Clinical Clinical Trials Clinical assessments Communities Data Decision Making Delirium Dementia Diabetes Mellitus Drug Prescriptions Effectiveness Elderly Electronic Health Record Funding Goals Health Care Costs Health Services Research Health Status Health system Healthcare Systems Heart failure Hip Fractures Home Hospitalization Hospitals Institutionalization Intensive Care Units Investigation Link Massachusetts Measurement Measures Medicare Methods Mission Modeling National Institute on Aging Operative Surgical Procedures Osteoporosis Outcomes Research Participant Patient Selection Patient-Centered Care Patients Peripheral arterial disease Persons Pharmaceutical Preparations Pharmacoepidemiology Pharmacotherapy Pneumonia Population Pragmatic clinical trial Provider Public Health Qualifying Randomized, Controlled Trials Research Research Personnel Resources Sampling Skilled Nursing Facilities System Testing Time United States National Institutes of Health Variant Ventilator Work acute care clinical care clinical practice clinically actionable comorbidity comparative effectiveness study cost critical limb Ischemia disability evidence base experience frailty health management hospital care improved indexing innovation medication safety personalized care poor health outcome population health pragmatic trial predictive modeling programs revascularization surgery risk prediction risk stratification routine care safety study treatment as usual treatment effect venous thromboembolism

项目摘要

PROJECT SUMMARY/ABSTRACT Older adults with frailty are more likely to experience poor health outcomes after acute illnesses, drug-related adverse events, and surgeries. Health care costs for frail patients double due to acute hospital care, post-acute care, and treatments for preventable conditions. Despite clinical and societal consequences of frailty, frailty is rarely assessed in clinical practice and little evidence exists on how to integrate frailty to inform clinical care and population health management. The critical step to generate this evidence is to measure frailty on a large scale with high accuracy and efficiency. To address this need, the investigator team recently developed and validated a claims-based frailty index (CFI), which enables measurement of frailty from Medicare data for large populations when in-person assessment is not feasible. The objective of this application is to generate evidence needed for frailty-guided clinical care and population health management by applying CFI to claims data-based studies of drug therapy; pragmatic clinical trials of procedural therapy; and electronic health records (EHR)-Medicare linked data of a health care system. The central hypothesis is that frailty information will improve care of older adults by uncovering meaningful variations in the treatment benefit-harm profile, costs, and resource needs. To test this hypothesis, the investigator team with extensive expertise in frailty, pharmacoepidemiologic methods, and health services research will accomplish the following specific aims in the next 5 years: 1) determine how frailty changes the benefits and harms of 10 prescription drugs for chronic conditions in older adults by applying CFI to the 2014-2022 5% Medicare random sample; 2) determine how frailty changes the benefits and harms of procedural therapies in older adults by applying CFI to Medicare data linked to 2 ongoing pragmatic clinical trials of endovascular vs surgical revascularization therapy for peripheral arterial disease and acupuncture vs usual care for chronic low back pain; and 3) determine whether implementing CFI to EHR-Medicare linked data can predict high-cost and high-need patients in a large health care system in Boston, Massachusetts. The innovative applications of CFI are readily scalable to claims-based comparative effectiveness and safety studies, clinical trials, and EHR in health care systems. The impact of this research is significant because the clinically actionable evidence generated from this research can enable optimal choice of drug and procedural therapy and a health system-wide risk stratification based on frailty. Ultimately, these results will accelerate integration of frailty in routine care and facilitate frailty-guided clinical care and population health management.

项目总结/摘要体弱的老年人在急性疾病、药物相关疾病和其他疾病后更有可能经历不良的健康结果。不良事件和手术。由于急性医院护理，急性后护理和治疗可预防的疾病。尽管虚弱的临床和社会后果，在临床实践中很少进行评估，关于如何整合虚弱以告知临床护理的证据很少，人口健康管理。产生这一证据的关键步骤是大规模测量脆弱性准确性高、效率高。为了满足这一需求，研究小组最近开发并验证了基于索赔的虚弱指数（CFI），可从大规模人群的Medicare数据中测量虚弱程度当亲自评估不可行时。此应用程序的目的是生成所需的证据，通过将CFI应用于基于索赔数据的研究，药物治疗;程序治疗的实用临床试验;和电子健康记录（EHR）-与医疗保险相关医疗保健系统的数据。核心假设是，脆弱信息将改善老年人的护理通过揭示治疗获益-危害概况、成本和资源需求的有意义的变化。测试这一假设，研究者团队在脆弱性，药物流行病学方法，在未来5年内，卫生服务研究将实现以下具体目标：1）确定脆弱性通过应用CFI改变10种处方药对老年人慢性病的益处和危害到2014-2022年5%的医疗保险随机样本; 2）确定脆弱如何改变的好处和危害，通过将CFI应用于与2项正在进行的实用临床试验相关的Medicare数据，在老年人中进行程序性治疗外周动脉疾病血管内与外科血运重建治疗以及针灸与常规治疗的比较慢性腰痛的护理;以及3）确定将CFI实施到EHR-Medicare关联数据是否可以预测马萨诸塞州波士顿的一个大型医疗保健系统中的高成本和高需求患者。创新 CFI的应用很容易扩展到基于索赔的比较有效性和安全性研究，临床试验和医疗系统中的EHR。这项研究的影响是重大的，因为临床上可操作的这项研究产生的证据可以使药物和程序治疗的最佳选择和健康基于虚弱程度的全系统风险分层。最终，这些结果将加速脆弱性的整合，常规护理，并促进虚弱指导的临床护理和人口健康管理。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Feasibility of implementing a telephone-based frailty assessment.

DOI：
10.1111/jgs.18031
发表时间：
2022-12
期刊：
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
影响因子：
6.3
作者：
Sison, Stephanie Denise M.;Newmeyer, Natalie;Arias, Karla Tejada;Schoenburg, Racheli;Valencia, Carolina Fonseca;Cheslock, Megan;Raman, Vaishnavi;Driver, Jane A.;Kim, Dae Hyun
通讯作者：
Kim, Dae Hyun

Osteoporosis Medications Prevent Subsequent Fracture in Frail Older Adults.

DOI：
10.1002/jbmr.4693
发表时间：
2022-11
期刊：
JOURNAL OF BONE AND MINERAL RESEARCH
影响因子：
6.2
作者：
Chattaris, Tanchanok;Oh, Gahee;Gouskova, Natalia A.;Kim, Dae Hyun;Kiel, Douglas P.;Berry, Sarah D.
通讯作者：
Berry, Sarah D.

Correction to: Change in a Claims-Based Frailty Index, Mortality, and Health Care Costs in Medicare Beneficiaries.

更正：医疗保险受益人基于索赔的衰弱指数、死亡率和医疗保健费用的变化。

DOI：
10.1093/gerona/glad190
发表时间：
2023
期刊：
The journals of gerontology. Series A, Biological sciences and medical sciences
影响因子：
0
作者：
通讯作者：

A crosswalk of commonly used frailty scales.

常用衰弱量表的人行横道。

DOI：
10.1111/jgs.18453
发表时间：
2023
期刊：
Journal of the American Geriatrics Society
影响因子：
6.3
作者：
Sison,StephanieDeniseM;Shi,SandraM;Kim,KyungMoo;Steinberg,Nessa;Jeong,Sohyun;McCarthy,EllenP;Kim,DaeHyun
通讯作者：
Kim,DaeHyun

Self-Reported Frailty and Health Care Utilization in Community-Dwelling Middle-Aged and Older Adults in the United States.

美国社区居住的中老年人自我报告的虚弱和医疗保健利用情况。