Assessment of Frailty Phenotype and Functional Limitations to Improve Prediction of Subsequent Health Care Utilization in Older Community-Dwelling Adults

评估虚弱表型和功能限制，以改善对社区老年人后续医疗保健利用的预测

• 批准号: 10646254
• 负责人: KRISTINE ENSRUD
• 金额: $ 44.83万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10646254
• 关键词: Accounting; Adult; Aging; Award; Behavioral; Biological; Body Composition; Body Weight decreased; Characteristics; Chronic; Clinical; Cohort Studies; Communities; Cost Savings; Data; Databases; Disease; Economics; Elderly; Evaluation; Fee-for-Service Plans; Funding; Future; Gait speed; Hand Strength; Health; Health Benefit; Health Care Costs; Health Expenditures; Health Insurance; Health care facility; Healthcare; Healthcare Systems; Hospitalization; Individual; Inpatients; Intervention; Intervention Trial; Link; Long-Term Care; Measures; Medical; Medicare; Medicare claim; Mission; Modeling; Outcome; Outpatients; Participant; Patient Self-Report; Patient risk; Patient-Centered Care; Patients; Persons; Phenotype; Prevalence; Process; Prospective cohort; Research; Risk; Risk Factors; Risk Reduction; Sampling; Variant; Woman; acute care; age related; aging population; cardiovascular health; care burden; care costs; clinical decision-making; clinical risk; cohort; cost; cost estimate; demographics; design; disability; epidemiology study; frailty; functional status; health care model; health care service utilization; health determinants; high risk population; improved; individual patient; instrumental activity of daily living; insurance claims; interest; men; multiple chronic conditions; older men; older women; osteoporosis with pathological fracture; outcome prediction; participant enrollment; practice setting; prevent; primary care practice; social; therapy design; trend

Health care burden as manifested by greater health care utilization rises markedly with advancing age due in part to increasing prevalence of multiple chronic medical conditions (multimorbidity). While multimorbidity is a robust risk factor for higher health care burden, current multimorbidity measures explain only a modest proportion of the variation in subsequent health care costs. In order to constrain health care burden without negatively impacting health outcomes, improved understanding of key determinants of health care utilization among older adults is essential. Risk factors from other domains (including potentially modifiable determinants) would enhance identification of older community-dwelling adults likely to require costly care. Thus, models of health care utilization including the potentially modifiable (but not routinely measured in clinical settings) domains of the frailty phenotype and self-reported functional limitations may improve characterization of patient risk profiles and therefore improve targeting and design of interventions to reduce subsequent health care burden. The overarching objective of this proposal is to construct interpretable, generalizable and validated models of health care costs and utilization among older community dwelling adults that identify clinical risk factors amenable to targeted interventions to reduce risk of subsequent extensive and costly health care. We will take advantage of the linkage between community-dwelling participants in four cohort studies of older adults (Study of Osteoporotic Fractures [SOF]; Osteoporotic Fractures in Men Study [MrOS]; Health Aging and Body Composition Study [Health ABC]; and National Health and Aging Trends Study [NHATS]) and their Medicare claims data. We will perform a comprehensive evaluation of key potential clinical risk factors (frailty phenotype, self-reported functional limitations and components of frailty phenotype and functional limitations) for higher health care costs and utilization, after accounting for demographics and claims-based indicators of multimorbidity and frailty. Our application is consistent with the NIA mission to conduct biological, clinical, behavioral, social, and economic research related to the diseases and conditions associated with the aging process. Our study combines a wide range of data from four large epidemiologic studies leveraging the value of these cohorts in an efficient manner. If our hypotheses are confirmed, findings from our analyses will more accurately characterize subsets of older community-dwelling adults at risk for intense, costly health care; benefit health care systems/payers estimating costs vs. benefits of interventions aimed at delaying progression to frailty and disability; support assessment of the frailty phenotype, functional status, or specific individual components of these domains in the outpatient primary care practice setting; and direct the design of future targeted intervention trials aimed at reducing health care costs and utilization among the aged population.

随着年龄的增长，医疗保健负担显着增加，表现为医疗保健利用率的增加， 部分原因是多种慢性疾病（多发病）的流行率不断增加。虽然多变量是一个 较高的医疗保健负担的强有力的风险因素，目前的多因素措施只能解释适度的 在随后的医疗保健费用的变化的比例。为了限制医疗负担， 对健康结果产生负面影响，提高对保健利用的关键决定因素的认识 在老年人中是必不可少的。来自其他领域的风险因素（包括可能改变的决定因素） 将加强对可能需要昂贵护理的社区老年人的识别。因此， 医疗保健利用率，包括潜在的可改变性（但在临床环境中不进行常规测量） 脆弱表型和自我报告的功能限制的结构域可能会改善患者的特征 风险概况，从而改进干预措施的针对性和设计，以减少随后的卫生保健 负担本提案的总体目标是构建可解释、可推广和可验证的 确定临床风险的老年社区居民的卫生保健费用和利用模型 有针对性的干预措施，以减少随后的广泛和昂贵的医疗保健的风险。我们 将利用四项老年人队列研究中社区居住参与者之间的联系， 成人（骨质疏松性骨折研究[SOF];男性骨质疏松性骨折研究[MrOS];健康老龄化和 身体成分研究[健康ABC];和全国健康和老龄化趋势研究[NHATS]）及其 医疗保险索赔数据。我们将对关键的潜在临床风险因素（虚弱）进行全面评估 表型、自我报告的功能限制以及虚弱表型和功能限制的组成部分） 在考虑人口统计和基于索赔的指标后， 多重人格和脆弱我们的应用与NIA的使命一致，即进行生物学、临床、 行为，社会和经济研究与疾病和与老龄化有关的条件 过程我们的研究结合了来自四项大型流行病学研究的广泛数据， 以一种有效的方式。如果我们的假设得到证实，我们的分析结果将更加 准确描述社区居住的老年人的亚群，这些老年人面临密集、昂贵的医疗保健的风险; 有利于医疗保健系统/支付者估计旨在延缓疾病进展的干预措施的成本与收益 脆弱和残疾;支持脆弱表型、功能状态或特定个体的评估 这些领域的组成部分在门诊初级保健实践设置;并指导未来的设计 有针对性的干预试验，旨在降低老年人的保健费用和利用率。