Trajectories and Palliation Study (TAPS)

轨迹和姑息治疗研究 (TAPS)

基本信息

批准号：
8258184
负责人：
Karl Lorenz
金额：
$ 45.08万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-27 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8258184
关键词：
Accounting Acute Address Caregivers Caring Cessation of life Characteristics Chronic Chronic Disease Climacteric Clinical Complex Data Diagnosis Dimensions Disease Effectiveness Elderly Emotional Event Expenditure Future Goals Health Health Surveys Healthcare Impairment Improve Access Intervention Life Life Expectancy Life Style Link Literature Longitudinal Surveys Malignant Neoplasms Malignant neoplasm of lung Measures Medicare Medicare claim Methodology Methods Modeling Organ failure Outcome Pain Palliative Care Patients Pattern Policies Population Prevalence Process Quality of Care Quality of life Recovery Research Research Priority Resources Retirement Review Literature Risk Role Science Services Signal Transduction Structure Surveys Thinking Time Treatment Cost United States Centers for Medicare and Medicaid Services United States National Institutes of Health Update Work advanced disease aging population base beneficiary cost demographics end of life evidence base experience frailty functional status hospice environment improved innovation meetings member new technology palliation palliative patient oriented payment prospective satisfaction simulation tool trend uptake

项目摘要

DESCRIPTION (provided by applicant): Evidence increasingly supports the role of palliative care in improving both the efficiency of care and the quality of life of patients and caregivers living with advanced chronic serious illness. Improving access to and use of palliative care is becoming more important with our aging population and prevalence of advanced chronic illness, as well as fiscal constraints on healthcare spending. RAND Health developed the Future Elderly Model (FEM) for the Center for Medicare and Medicaid Services (CMS) to evaluate the impact of healthcare innovations on the utilization and cost of care, as well as patient and caregiver outcomes. RAND has used FEM to evaluate the future impact of changing demographics, lifestyle choices, novel technologies, and other trends for CMS. We propose to evaluate trajectories of serious chronic illness using data from the Medicare Current Beneficiary Survey (MCBS) and the Health and Retirement Survey (HRS) to characterize function, pain, emotional wellbeing over time among patients and their caregivers, comparing both prospective and retrospective approaches, and narrow and broad categorizations of cancer, organ failure, and frailty trajectories. We will evaluate a range of patient characteristics and healthcare events tha are associated with critical changes in those trajectories, in order to characterize possible triggers for implementing palliative care. We will update and expand extensive literature reviews we previously conducted for the NIH State of the Science Meeting on End of Life Care in 2004 in order to synthesize the literature on the effectiveness of palliative services including hospice in improving QOL, utilization, and cost outcomes. Informed by the literature, an expert panel will then rate the feasibility and validity of policy scenarios to implement palliative care hat address the timing, setting, and composition of palliative care services. Finally, informed by our empiric examination of trajectories, a synthesis of the literature, and ratings of the panel, we wil use the FEM to consider the impact of the highest priority policy scenarios to implement palliative care services on patients, caregivers, and Medicare utilization and cost. Our team has worked closely together conducting research on policy-relevant aspects of palliative and end of life care, and members of our team have extensive policy experience developing, implementing, and evaluating policies to improve the care of advanced serious chronic illness. We have tremendous expertise in the methods of the proposed project including quantitative analyses, literature syntheses, appropriateness panel methodologies, and policy dissemination. This project will not only inform policy, but also identify critical gaps in the understanding of trajectories and the effectiveness of palliative care to inform research priorities. PUBLIC HEALTH RELEVANCE: The overall aim of this proposal is to identify evidence-based approaches to administration of quality of life preserving services in patients with advanced disease and forecast the impact of such approaches on utilization, costs, patient and caregiver quality of life related outcomes. In particular, we are concerned with optimal timing, implementation, and composition of palliative care in consideration of decline and recovery in multiple dimensions of patients' quality of life, and the impact of policies based on this evidence on patients, their caregivers, and utilization and treatment patterns.

描述（由申请人提供）：证据越来越多地支持姑息治疗在提高护理效率以及患者和护理人员的生命质量方面的作用，并患有晚期慢性严重疾病。随着我们老龄化的人口和晚期慢性病的患病率以及医疗保健支出的财政限制，改善姑息治疗的获得和使用变得越来越重要。 Rand Health开发了医疗保险和医疗补助服务中心（CMS）的未来老年人模型（FEM），以评估医疗保健创新对护理利用率和成本的影响以及患者和护理人员的结果。兰德（Rand）使用FEM来评估不断变化的人口统计学，生活方式选择，新技术和其他CMS趋势的未来影响。我们建议使用Medicare当前受益人调查（MCB）和健康与退休调查（HRS）的数据评估严重的慢性病轨迹，以表征患者及其护理人员之间的功能，疼痛，随着时间的流逝随着时间的流逝，并比较前瞻性和追溯方法，以及癌症，机构失败，机构失败，机器人失败，狭窄和广泛的分类。我们将评估一系列患者特征和医疗保健事件与这些轨迹的关键变化有关，以表征实施姑息治疗的可能触发因素。我们将更新和扩展我们先前针对2004年生命终止的NIH科学会议的广泛文献评论，以综合有关姑息服务的有效性的文献改善QOL，利用率和成本成本的临终关怀。随后，专家小组将对政策方案的可行性和有效性进行评分，以实施姑息治疗帽子的可行性和有效性，以解决姑息治疗服务的时间，设置和组成。最后，通过对轨迹的经验检查，文献的综合以及小组的评分，我们将使用FEM来考虑最高优先级政策情景对患者，护理人员，医疗保险利用和成本实施姑息治疗服务的影响。我们的团队已经密切合作，共同进行了有关姑息治疗和生命终结方面的政策方面的研究，我们团队的成员具有广泛的政策经验，制定，实施和评估政策，以改善对先进严重慢性病的护理。我们在拟议项目的方法方面拥有巨大的专业知识，包括定量分析，文献合成，适当性小组方法论和政策传播。该项目不仅会为政策提供依据，而且还可以确定对轨迹的理解以及姑息治疗的有效性以告知研究优先级的关键差距。公共卫生相关性：该提案的总体目的是确定基于证据的方法来管理晚期疾病患者的生活质量，并预测这种方法对利用，成本，患者和照顾者生活质量相关的结果的影响。特别是，考虑到患者生活质量的多个维度的下降和恢复，我们关注姑息治疗的最佳时机，实施和组成，以及基于此证据的政策影响关于患者，他们的护理人员以及利用和治疗模式。