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: 10807545
• 负责人: KRISTINE ENSRUD
• 金额: $ 26.22万
• 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 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10807545
• 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，医疗保健负担随着年龄的增长而显著增加，主要表现为医疗保健利用率的提高