Aging, comorbid conditions, and health care utilization in persons with HIV

艾滋病毒感染者的老龄化、合并症和医疗保健利用

• 批准号: 8714607
• 负责人: IRA B WILSON
• 金额: $ 73.64万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-07 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8714607
• 关键词: Acquired Immunodeficiency Syndrome; Address; Admission activity; Affect; Age; Aging; Aging-Related Process; Alcohol consumption; Basic Science; Biological; Cardiovascular Diseases; Caring; Chronic; Clinical; Comorbidity; Data; Data Set; Data Sources; Development; Diabetes Mellitus; Disabled Persons; Disease; Effectiveness; Epidemiology; Event; Evidence based intervention; Future; Goals; HIV; HIV Infections; Habits; Health; Health Services; Health Services Research; Home Nursing Care; Hospitalization; Impaired cognition; Incidence; Institutionalization; Intervention; Justice; Life; Link; Literature; Liver diseases; Lung diseases; Medicaid; Medicare; Mental Depression; Mental Health; Mental disorders; Methods; Mission; Morbidity - disease rate; Neurocognitive; Nursing Homes; Opportunistic Infections; Outcome; Patients; Persons; Physicians; Policies; Policy Maker; Population; Population Control; Prevalence; Psyche structure; Qualifying; Quality of Care; Recurrence; Research; Research Methodology; Research Personnel; Sampling; Smoking; Substance abuse problem; Universities; Virus Diseases; Work; advanced disease; age effect; antiretroviral therapy; base; burden of illness; cognitive function; cohort; cost; disability; disorder control; end of life; evidence base; experience; federal policy; frailty; functional decline; functional status; health care service utilization; improved; innovation; interest; mortality; multidisciplinary; normal aging; novel; premature; public health relevance; service utilization; tool

DESCRIPTION: Patients with HIV are experiencing higher than expected rates of Non-AIDS (HANA) conditions as they age that contribute to premature morbidity and mortality. An important barrier to improving these outcomes is that there are no nationally generalizable data showing how HANA conditions disease impact rates of burdensome and costly health care utilization (e.g. recurrent hospitalization), and how this changes with aging. Addressing this barrier will permit the development of evidence-based clinical interventions and facilitate policy planning. The long term goal of this research is to reduce unnecessary and costly health care utilization and institutionalization for aging persons with HIV. The objective of this application, the first step toward this long term goal, is to understand how age and selected HANA conditions (diabetes, cardiovascular disease, liver disease, pulmonary disease, and psychiatric disease) interact to affect key health care utilization events. We propose to study a 14-state, nationally representative, sample of Medicaid patients, and for those admitted to a nursing home, link the Medicaid files to nursing home Minimum Data Set (MDS). The central hypothesis of this proposal is that these HANA conditions may accelerate or accentuate frailty and functional decline, producing premature and burdensome utilization and institutionalization. The rationale for this hypothesis is that aging in persons with HIV has been associated with higher rates of chronic conditions and higher mortality than control population, but no literature that we are aware of examines the kind of care utilization that frailty and functional decline produces, or quantifies the effects of age and comorbidity on this utilization. This proposal is relevant to the NIH's mission because it seeks to reduce the burdens of illness and disability for a growing group - persons aging with HIV. This study has three Specific Aims: 1) Describe the prevalence and incidence of the selected co-morbid conditions in HIV+ persons, and describe how incidence and prevalence vary with chronologic age; 2) Calculate the rate of burdensome health care utilization, nursing home use, and permanent nursing home placement as a function of chronologic age in HIV+ persons, and show how this relationship changes with the presence of the selected co-morbid conditions; and 3) Calculate the rate of functional and cognitive decline among HIV+ nursing home residents as a function of chronological age, and show how this relationship changes with the presence of the selected co-morbid conditions. This approach is innovative because we use a nationally representative sample, employ methods and approaches from health services research not previously applied to aging and HIV, link Medicaid and MDS data, and develop new analytic tools to study burdensome service utilization in Medicaid patients with HIV. The approach is significant because it can generate hypotheses about biological mechanisms in aging that can guide future work, and also because state and federal policy makers need such data to plan for future care needs. The evidence from this project will lay the groundwork for future analyses of quality and costs of care for aging patients with HIV.

产品说明：随着年龄的增长，艾滋病毒感染者的非艾滋病（HANA）状况发生率高于预期，这导致过早发病和死亡。改善这些结果的一个重要障碍是，没有全国性的可推广数据显示HANA疾病如何影响负担沉重和昂贵的医疗保健利用率（例如，反复住院），以及这种情况如何随着老龄化而变化。解决这一障碍将使循证临床干预措施的发展和促进政策规划。这项研究的长期目标是减少不必要的和昂贵的卫生保健利用和机构的老年人与艾滋病毒。本申请的目的， 实现这一长期目标的第一步是了解年龄和选定的HANA状况（糖尿病、心血管疾病、肝病、肺病和精神病）如何相互作用以影响关键的卫生保健利用事件。我们建议研究一个14个州的，具有全国代表性的，医疗补助患者的样本，并为那些住进疗养院，链接医疗补助文件的疗养院最小数据集（MDS）。该提案的核心假设是，这些HANA条件可能会加速或加剧虚弱和功能衰退，导致过早和繁重的使用和制度化。这一假设的基本原理是，与对照人群相比，艾滋病病毒感染者的老龄化与慢性病发病率和死亡率较高有关，但没有文献表明我们 意识到检查虚弱和功能衰退产生的护理利用类型，或 量化了年龄和合并症对这种利用的影响。该提案与 NIH的使命，因为它寻求减少疾病和残疾的负担，为越来越多的群体-人的老龄化与艾滋病毒。本研究有三个具体目的：1）描述HIV+人群中所选共病的患病率和发病率，并描述发病率和患病率如何随年龄变化; 2）计算HIV+人群中负担沉重的卫生保健利用率、疗养院利用率和永久性疗养院安置率，作为年龄的函数，并显示这种关系如何随着所选共病状况的存在而变化;和3）计算HIV+疗养院居民的功能和认知能力下降率作为实足年龄的函数，并且示出了这种关系如何随着所选择的共病状况的存在而变化。这种方法是创新的，因为我们使用了具有全国代表性的样本，采用了以前未应用于老龄化和艾滋病毒的卫生服务研究的方法和途径，将医疗补助和MDS数据联系起来，并开发了新的分析工具来研究医疗补助艾滋病毒患者的繁重服务利用率。这种方法很重要，因为它可以产生关于衰老生物机制的假设，可以指导未来的工作，也因为州和联邦政策制定者需要这些数据来规划未来的护理需求。该项目的证据将为未来分析老年患者的护理质量和成本奠定基础 感染了艾滋病毒