Prognostic Indices for Hospitalized Older Adults with and without Alzheimer’s Disease and Related Dementias

患有或不患有阿尔茨海默病和相关痴呆症的住院老年人的预后指数

• 批准号: 10740664
• 负责人: Sei Lee
• 金额: $ 82.12万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740664
• 关键词: Age; Alzheimer' s disease related dementia; Antihypertensive Agents; Chronic; Clinic; Communities; Conscious; Data; Data Element; Delirium; Development; Effectiveness; Elderly; Electronic Health Record; Eligibility Determination; Ensure; Equity; Exclusion; Health Services; Healthcare Systems; Hospice Care; Hospitalization; Hospitals; Israel; Laboratories; Length of Stay; Life; Lipids; Measures; Medical center; Methodology; Methods; Modeling; Online Systems; Outpatients; Palliative Care; Patients; Persons; Pharmaceutical Preparations; Physical Function; Physiological; Positioning Attribute; Prognosis; Publications; Qualifying; Research; Role; Site; Standardization; System; Techniques; Validation; Work; acute care; clinical decision-making; clinical diagnosis; cohort; collaboratory; design; effectiveness validation; end of life; experience; functional status; health care quality; health care service; high risk; hospice environment; improved; indexing; innovation; model building; mortality; mortality risk; neighborhood disadvantage; nonalzheimer dementia; online resource; outcome prediction; patient prognosis; personalized predictions; predictive modeling; predictive tools; prognostic index; prognostic model; prognostic value; social health determinants

Project Summary/Abstract We will develop and externally validate electronic health record (EHR)-based prognostic indices to improve healthcare quality for hospitalized older adults by identifying patients most likely to qualify for (and benefit from) specific health services. Our indices will predict: 1) 6-month mortality to guide hospice referral decisions; and 2) 2-year mortality to guide outpatient palliative care referrals and inform medication deprescribing. We will develop each of these indices for patients with and without Alzheimer’s disease and related dementias, since previous studies suggest that the trajectory of decline differs between older adults with and without Alzheimer’s disease and related dementias. Function is critically important to prediction in older adults, particularly those with Alzheimer’s disease and related dementias, and we have shown that the prognostic power of function increases with age. A major limitation that has hindered the effectiveness of predictive indices for hospitalized older adults has been the lack of functional data in the EHR. Recently, recognizing the critical role of function in providing high quality healthcare to older adults, hospital systems have started to routinely assess and document functional status. This development facilitates our proposal since we now have access to routine functional data from several hospitals, allowing us to incorporate these data into prognostic indices. With EHRs becoming ubiquitous in healthcare systems, our externally validated indices could be integrated into the EHR in most hospitals. To facilitate use in hospitals without EHR integration, we will develop parsimonious indices (also for ADRD and non-ADRD patients) available on ePrognosis, our free and widely used online compendium of geriatric prediction indices. We will set a new standard for equity-conscious prognostic model building by “baking equity” into model selection and incorporating neighborhood disadvantage as predictor representing social determinants of health. We have established a 4 site Collaboratory, which all routinely collect physical function data, clinical diagnoses, standardized delirium assessments, laboratory values, and physiologic measures: UCSF & Cleveland Clinic (development cohort); and Beth Israel Deaconess Medical Center & Johns Hopkins (external validation cohort). We propose to: (1) Develop full prognostic indices designed to be embedded in EHRs for 6-month and 2-year mortality for hospitalized older adults with and without Alzheimer’s disease and related dementias; (2) Develop parsimonious web-based prognostic indices designed to be accessed through ePrognosis for 6-month and 2-year mortality for older adults with and without Alzheimer’s disease and related dementias; (3) To internally validate the effectiveness of these prognostic indices; and (4) to externally validate these indices. These indices will help clinicians improve healthcare quality for older adults by prompting alignment of patient prognosis with health services (i.e. hospice and palliative care referrals) and deprescribing decisions.

项目摘要/摘要 我们将开发和外部验证电子健康记录（EHR）的预后指数以改进 通过确定最有可能获得（并从中受益）的患者，用于住院老年人的医疗保健质量 特定的卫生服务。我们的指数将预测：1）6个月的死亡率指导临终关怀转诊决定；和 2）为指导门诊姑息治疗转介的2年死亡率并为药物分类提供了信息。我们将 为患有和患有阿尔茨海默氏病和相关痴呆症患者的患者开发这些指数，因为 先前的研究表明，患有和没有阿尔茨海默氏症的老年人之间的下降轨迹有所不同 疾病和相关痴呆症。功能对于老年人的预测至关重要，尤其是那些 有了阿尔茨海默氏病和相关痴呆症，我们已经证明了功能的预后能力 随着年龄的增长而增加。一个主要限制，阻碍了预测指数的有效性 老年人在EHR中缺乏功能数据。最近，认识到功能在 为老年人提供高质量的医疗保健，医院系统已开始定期评估和 文档功能状态。这种发展最喜欢我们的建议，因为我们现在可以访问日常工作 来自多家医院的功能数据，使我们能够将这些数据纳入预后指数。与EHRS 在医疗保健系统中无处不在，我们经过外部验证的指标可以集成到EHR中 在大多数医院。为了促进没有EHR整合的医院使用，我们将开发简约的指数 （也适用于ADRD和非ADRD患者）可在我们免费且广泛使用的eProghosis上获得 老年预测指数的汇编。我们将为具有股票意识的预后模型设定新标准 通过“烘焙权益”构建到模型选择中，并将邻里灾难纳入预测指标 代表健康的社会决定者。我们已经建立了一个4个网站协作，所有这些都经常 收集身体功能数据，临床诊断，标准化的ir妄评估，实验室价值以及 生理指标：UCSF和Cleveland诊所（开发队列）；和贝丝以色列执事医疗 中心和约翰·霍普金斯（外部验证队列）。我们建议：（1）制定完整的预后指标 旨在将住院老年人和2年的EHR嵌入EHR中 没有阿尔茨海默氏病和相关痴呆症； （2）开发基于Web的简约预后指标 旨在通过有或没有 阿尔茨海默氏病和相关痴呆症； （3）在内部验证这些预后的有效性 指数； （4）外部验证这些指数。这些指数将帮助临床医生改善医疗保健 通过提示患者提示与健康服务的一致（即临终关怀和 姑息治疗转介）和划分的决定。