Comparing hospitalization rates, outcomes, and treatment intensity for elderly patients across OECD countries

比较经合组织国家老年患者的住院率、结果和治疗强度

• 批准号: 10614912
• 负责人: Peter M Cram
• 金额: $ 49.58万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10614912
• 关键词: Abdominal Aortic Aneurysm; Academy; Acute; Acute myocardial infarction; Admission activity; Affect; Age; Age Distribution; Algorithms; Aortic Aneurysm; Canada; Cardiac Catheterization Procedures; Carotid Arteries; Clinical; Collaborations; Comparative Study; Congestive Heart Failure; Consult; Country; Data; Development; Disadvantaged; Disease; Disparity population; Economics; Elderly; England; Epidemiology; Future; Health; Health system; Healthcare; Healthcare Systems; Hip Fractures; Hospitalization; Hospitals; Image; Income; Inequality; Infant Mortality; Inferior; Injury; International; Investments; Ischemic Stroke; Israel; Knowledge; Learning; Length of Stay; Life Expectancy; Literature; Measures; Medical; Medicine; Methods; Netherlands; Older Population; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Pattern; Performance; Policies; Population; Population Study; Procedures; Province; Replacement Arthroplasty; Research; Research Methodology; Research Personnel; Research Support; Resource Allocation; Sex Distribution; Site; Social Work; Societal Factors; Socioeconomic Status; Time; Tracer; Treatment Effectiveness; Treatment outcome; Update; Vascularization; Visit; Work; acute care; common treatment; comorbidity; comparative; cost; experience; head-to-head comparison; health care service utilization; health difference; hospital readmission; hospitalization rates; improved; insight; low socioeconomic status; mortality; older patient; peer; population health; procedure cost; repaired; safety net; social; social deprivation; treatment comparison; treatment pattern

In 2011 the National Academy of Medicine convened a panel to explore the paradox of why the US spends more on healthcare than other Organization of Economic Cooperation and Development (OECD) countries yet has inferior outcomes. It concluded that “Data are simply lacking to fully understand the causal factors responsible for each of the diseases and injuries that disproportionately affect the US population.” Although aggregate measures of health systems performance such as life expectancy and infant mortality rates suggest that US health care system performance lags, a limited number of direct comparisons of medical treatments suggest that the US may have better outcomes than OECD peers for acute conditions including hip fracture (HF) and acute myocardial infarction (AMI). Modestly improved US outcomes, however, come at the expense of extraordinarily high utilization of cardiac catheterization for AMI and other costly procedures. Moreover, disadvantaged populations in the US may fare worse than disadvantaged populations in other countries. It is a convenient narrative to simply conclude that the US spends more and gets less from an underperforming healthcare system. Yet, there may be a more nuanced story. Some research supports the notion that differences in where money is spent (acute care vs. social services) might explain part of the differences in health outcomes. Thus further rigorous research is needed to understand better the contributions of the health care system to outcomes. We propose to update a disjointed, incomplete and outdated literature by systematically studying patterns of utilization, outcomes, and treatment intensity for older adults with specific acute conditions treated in wealthy countries with vastly different healthcare systems. Our research will inform the debate about whether more intensive treatment practices in the US also lead to better outcomes. The overarching objective of our study is to compare treatment for older adults from five OECD countries (US, Canada, Netherlands, Israel and England) hospitalized with one of 5 carefully selected tracer conditions: hip fracture (HF), acute myocardial infarction (AMI); ischemic stroke, elective aortic aneurysm repair (AAA), and congestive heart failure (CHF). Our proposal has five specific aims that assess: (1) differences in the epidemiology of the conditions; (2) differences in treatment intensity; (3) differences in outcomes, including mortality at 90 days and one year; (4) differences after stratifying by socioeconomic status and overall health; and (5) differential changes in treatment patterns over time. Our proposed work will provide a nuanced understanding of the effectiveness of treatment approaches in the five countries and will provide insights into the functioning of their health care systems. The scientific premise of our proposal is that granular information is needed to inform the study of comparative health systems. In addition, the international collaboration that we form for this proposal will serve as the basis for developing research methods and expertise in using nationally representative data to compare healthcare across countries.

2011年，美国国家医学院（National Academy of Medicine）召集了一个专家小组，探讨美国为什么要在 比其他经济合作与发展组织（OECD）成员国更多 结果都很差它的结论是，“数据只是缺乏充分了解的因果因素， 对每一种对美国人口造成不成比例影响的疾病和伤害负有责任。”虽然 对卫生系统绩效的总体衡量，如预期寿命和婴儿死亡率，表明 美国医疗保健系统的表现滞后，医疗治疗的直接比较数量有限， 这表明，美国在包括髋部骨折在内的急性疾病方面的结果可能优于经合组织同行 (HF)和急性心肌梗死（AMI）。然而，美国经济成果的适度改善是以牺牲 心脏导管插入术在AMI和其他昂贵手术中的使用率非常高。此外，委员会认为， 美国的弱势群体可能比其他国家的弱势群体更糟糕。 这是一种方便的叙述，可以简单地得出结论，美国从表现不佳的国家中支出更多，获得更少。 医疗保健系统。然而，可能有一个更微妙的故事。一些研究支持这样一种观点， 钱花在哪里的差异（急性护理与社会服务）可能解释了部分差异， 健康成果。因此，需要进一步严格的研究，以更好地了解健康的贡献， 护理系统的结果。我们建议更新一个脱节，不完整和过时的文献， 系统地研究了老年人特定疾病的利用模式、结果和治疗强度， 富裕国家的医疗保健系统差异很大。我们的研究将为 关于在美国更强化的治疗实践是否也会导致更好的结果的争论。 我们研究的首要目标是比较来自五个经合组织国家（美国， 加拿大、荷兰、以色列和英国）因5种精心选择的示踪剂疾病之一住院：髋关节 骨折（HF）、急性心肌梗死（AMI）、缺血性卒中、择期主动脉瘤修复术（AAA），以及 充血性心力衰竭（CHF）。我们的建议有五个具体的目标，评估：（1）差异， 疾病的流行病学;（2）治疗强度的差异;（3）结局的差异，包括 （4）按社会经济地位和总体健康状况分层后的差异; 以及（5）治疗模式随时间的不同变化。我们提出的工作将提供一个细致入微的 了解这五个国家治疗方法的有效性，并将深入了解 他们的医疗保健系统的运作。我们的建议的科学前提是， 为比较卫生系统的研究提供信息。此外，国际合作， 我们为这项建议所形成的形式将作为发展研究方法和专门知识的基础， 具有全国代表性的数据，以比较各国的医疗保健。