New EHR-based multimorbidity index for diverse populations across the lifespan: development, validation, and application
针对不同人群整个生命周期的新的基于 EHR 的多病指数:开发、验证和应用
基本信息
- 批准号:10720597
- 负责人:
- 金额:$ 61.7万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-09-30 至 2028-05-31
- 项目状态:未结题
- 来源:
- 关键词:AcuteAdultAdvisory CommitteesAffectAgeAge YearsAgingAlgorithmsBiological MarkersCOVID-19COVID-19 mortalityCOVID-19 prognosisCaliforniaCensusesChronicClinicalCodeCommunitiesDataData LinkagesData SetDevelopmentDiseaseElderlyElectronic Health RecordEquipment and supply inventoriesEthnic OriginFutureGeneral PopulationGoalsGuidelinesHealthHealth PolicyHealth systemHospitalizationImmunizationInterventionLife Cycle StagesLinkLongevityMeasurementMeasuresMethodsModelingOutcomePatient CarePatientsPhenotypePhysical FunctionPoliciesPolicy MakerPolypharmacyPopulationPopulation HeterogeneityPopulation PoliciesQuality of CareRaceRecommendationResearchResearch PersonnelResource AllocationRiskRisk AdjustmentStandardizationSurveysTestingVaccinatedVaccinesValidationWeightburden of illnessclinical careclinically relevantcohortcomorbiditycoronavirus diseasecostdisabilityeffective interventionelectronic health dataepidemiology studyfrailtyfunctional statushealth care service utilizationhealth datahealth managementhealth related quality of lifeimprovedimproved outcomeindexinginterestmortalitymortality riskmultiple chronic conditionspatient orientedpoor health outcomepopulation healthrisk stratificationsexshared decision makingsocial deprivationtoolunvaccinatedvirtual
项目摘要
Project Summary / Abstract
Virtually all U.S. adults will develop multimorbidity (coexistence of multiple chronic conditions) by late
adulthood. The sequelae are substantial: vulnerability to acute illness, disease exacerbation, hospitalization,
disability, poor health-related quality of life, and mortality. Despite this, there are no viable, patient-centered
measures for multimorbidity in the electronic health record (EHR) that include a comprehensive inventory of
conditions based on their impacts on physical functioning in community-dwelling adults and are thus broadly
applicable for the general population. The absence of such tools impedes systematic efforts to develop
effective interventions for patients with multimorbidity. To bridge these gaps, this proposal aims to develop and
validate a robust, clinically relevant, readily-available EHR-based multimorbidity-weighted index (eMWI) that
accurately ascertains disease presence using EHR data and is applicable for diverse populations across the
lifespan. The central hypothesis is that a comprehensive multimorbidity index that weights conditions based on
their impacts on physical functioning can more precisely quantify multimorbidity and provide a better model fit
to predict key health outcomes than prior measures. This hypothesis is strongly supported by our preliminary
results using large national surveys and survey-linked claims data, in which we rigorously developed and
validated a comprehensive set of 91 chronic conditions weighted by their average impacts on physical
functioning over the disease life course, thus incorporating illness burden and physical functioning into a
clinically meaningful measure applicable for the general population. As a transformative step for multimorbidity
measurement in patient care, population health, and research using EHR data, the team aims to 1) improve
multimorbidity measurement by more accurately ascertaining disease cases, and merging these with validated
physical functioning disease weights to create a new patient-centered eMWI applicable to diverse populations;
2) assess the validity of eMWI via its association with key clinical outcomes: multimorbidity progression,
hospitalization, and mortality; and 3) test the applicability of eMWI to national population health and policy by
applying it to evaluate the risk of severe and fatal COVID-19 among vaccinated vs. unvaccinated adults based
on their multimorbidity. This study uses large, diverse EHR data from 6 California health systems (>6 million
adults) with unique data linkages to census data, and the largest, most nationally-representative National
COVID Cohort Collaborative (N3C) dataset (>5 million COVID cases). The results will yield a new, validated,
patient-centered multimorbidity index for EHR data – the eMWI – to help guide clinical decisions, population-
health management, policy, and research for diverse populations. The team anticipates that eMWI can directly
impact future practice and outcomes in which multimorbidity and functional status impact everyday treatment
decisions and outcomes. eMWI will be readily available in standardized code for other EHR data. Overall,
these results will improve the quality of care and health outcomes for diverse, aging adults with multimorbidity.
项目总结/摘要
几乎所有的美国成年人都会发展成多发病(多种慢性病共存),
成年后遗症是巨大的:易患急性病,疾病恶化,住院治疗,
残疾、健康相关生活质量差和死亡率。尽管如此,没有可行的,以病人为中心的
电子健康记录(EHR)中的多项措施,包括全面的
根据其对社区居住成年人身体功能的影响,
适用于一般人群。缺乏这些工具阻碍了系统地努力发展
对多发性硬化症患者进行有效干预。为了弥补这些差距,本提案旨在发展和
验证一个强大的,临床相关的,容易获得的基于EHR的多发病加权指数(eMWI),
使用EHR数据准确地确认疾病存在,并适用于整个
寿命核心假设是,一个综合的多变量指数,加权条件的基础上,
它们对身体功能的影响可以更精确地量化多变量,并提供更好的模型拟合
来预测关键的健康结果。这一假设得到了我们初步研究的有力支持。
使用大型全国调查和与调查相关的索赔数据得出的结果,我们在其中严格开发并
验证了一套全面的91慢性疾病加权的平均影响,
在疾病的生命过程中发挥作用,从而将疾病负担和身体功能纳入一个
适用于一般人群的具有临床意义的指标。作为一个变革性的一步,
在病人护理,人口健康和使用EHR数据的研究测量,该团队的目标是1)提高
通过更准确地确定疾病病例,并将这些病例与经过验证的
身体功能疾病权重,以创建适用于不同人群的新的以患者为中心的eMWI;
2)通过其与关键临床结局的相关性评估eMWI的有效性:多肿瘤进展,
住院率和死亡率;以及3)通过以下方式测试eMWI对国家人口健康和政策的适用性:
应用它来评估接种疫苗与未接种疫苗的成年人之间严重和致命的COVID-19的风险,
在他们的多形态。本研究使用来自6个加州卫生系统(> 600万)的大量、多样化的EHR数据
成年人),与人口普查数据有独特的数据联系,以及最大、最具全国代表性的国家统计局。
COVID队列协作(N3 C)数据集(> 500万COVID病例)。结果将产生一个新的,经过验证的,
以患者为中心的EHR数据多指标指数-eMWI -帮助指导临床决策,人群-
健康管理,政策和研究,为不同的人群。该团队预计,eMWI可以直接
影响未来实践和结果,其中多功能和功能状态影响日常治疗
决定和结果。eMWI将以标准化代码随时提供给其他EHR数据。总的来说,
这些结果将提高护理质量和健康结果的多样化,老年人与多morphine。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Melissa Wei其他文献
Melissa Wei的其他文献
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{{ truncateString('Melissa Wei', 18)}}的其他基金
Cumulative and synergistic impact of chronic diseases on physical functioning in older adults: development and validation of a novel measure of multimorbidity
慢性病对老年人身体功能的累积和协同影响:多发病新测量方法的开发和验证
- 批准号:
10319278 - 财政年份:2017
- 资助金额:
$ 61.7万 - 项目类别:
Cumulative and Synergistic Impact of Chronic Diseases on Physical Functioning in Older Adults: Development and Validation of a Novel Measure of Multimorbidity
慢性病对老年人身体功能的累积和协同影响:多重发病新测量方法的开发和验证
- 批准号:
10599802 - 财政年份:2017
- 资助金额:
$ 61.7万 - 项目类别:
Cumulative and synergistic impact of chronic diseases on physical functioning in older adults: development and validation of a novel measure of multimorbidity
慢性病对老年人身体功能的累积和协同影响:多发病新测量方法的开发和验证
- 批准号:
9925770 - 财政年份:2017
- 资助金额:
$ 61.7万 - 项目类别:
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