Creating a better index for measuring multimorbidity in older adults

背景：多种慢性疾病（multimorphine）的存在对健康有着深远的影响， 和老年人的医疗保健。因此，对老年人的流行病学和临床研究取决于 能够以准确和概念上有效的方式测量多莫尔。然而，现有的方法 测量多变量存在严重的差距。大多数使用常用数据的现有措施 资料来源只包括预测住院和死亡的疾病。这些方法不适合测量 多Morphosis的其他方面，包括其对老年人在日常生活中独立运作的能力的影响 - 这一结果对这一人群至关重要。庞大且不断增长的研究和临床 因此，侧重于功能成果的方案缺乏解决多重障碍的适当工具。创新 索赔数据的使用为制定新的多索赔措施提供了很大的希望， 功能性成果。此外，这些方法提供了一个独特的机会，以改善现有的 多死亡指标侧重于“传统”结果，如住院和死亡。 目的：（1）开发和验证基于索赔的多项指标，预测能力下降， 进行基本和工具性日常生活活动（ADL，IADL）;（2）使用扩大的疾病范围 索赔数据中可衡量的特征，以制定和验证预测 住院和死亡;（3）比较我们的功能下降指标的预测有效性， 住院和死亡与现有的措施，如查尔森指数的多发病。 方法：使用医疗保险索赔数据与来自健康和退休的自我报告ADL和IADL数据相关联。 研究中，我们将使用预测模型开发的框架建立4个多变量指标。每个 将制定一个指数，以预测与多发性硬化有关的单独结果，包括 进行ADL（例如洗澡）、进行IADL（例如购物）的能力下降、住院和死亡。 这些模型中的预测因素将是可以在索赔数据中测量的疾病特征，包括 疾病、疾病严重程度的标志物和疾病-疾病相互作用。这些预测模型将 转换成简单的指数，其中每个疾病特征将被分配一些点， 这些点的总和将给出患者水平的多项评分。我们将在内部验证我们的指数， 自举技术，并在国家卫生和社会保障部的一组老年人中进行外部验证， 老化趋势研究。在整个过程中，我们将咨询一组专家顾问，以确保我们 以最大限度地对研究人员和卫生系统领导人有用的方式制定我们的措施。 相关性/公共卫生意义：反映以患者为中心的多项指标得到改善 结果将成为临床流行病学、卫生服务研究和临床项目的重要工具， 改善对老年人的照顾。

Background: The presence of multiple chronic conditions (multimorbidity) has profound impacts on the health and health care of older adults. As a result, epidemiologic and clinical research on older adults depends on being able to measure multimorbidity in an accurate and conceptually valid manner. Yet, existing methods of measuring multimorbidity have critical gaps. Most existing measures that use commonly-available data sources include only diseases that predict hospitalization and death. These methods are ill-suited to measure other aspects of multimorbidity, including its impact on older adults' ability to function independently in daily life – an outcome of vital importance to this population. The large and growing body of research and clinical programs that focus on functional outcomes thus lack the proper tools to address multimorbidity. Innovative uses of claims data hold great promise to develop new measures of multimorbidity focused on its impact on functional outcomes. Moreover, these approaches offer a unique opportunity to improve upon existing multimorbidity measures that focus on “traditional” outcomes such as hospitalization and death. Aims: (1) To develop and validate claims-based measures of multimorbidity that predict decline in ability to perform basic and instrumental activities of daily living (ADLs, IADLs); (2) Using an expanded range of disease characteristics measurable in claims data, to develop and validate measures of multimorbidity that predict hospitalization and death; (3) To compare the predictive validity of our measures for functional decline, hospitalization, and death with existing measures of multimorbidity such as the Charlson Index. Methods: Using Medicare claims data linked to self-report ADL and IADL data from the Health and Retirement Study, we will build 4 indices of multimorbidity using the framework of prognostic model development. Each index will be developed to predict a separate outcome related to multimorbidity, including decline in ability to perform ADLs (e.g. bathing), decline in ability to perform IADLs (e.g. shopping), hospitalization, and death. Predictors in these models will be disease characteristics that can be measured in claims data including diseases, markers of disease severity, and disease-disease interactions. These prognostic models will be converted into simple indices, where each disease characteristic will be assigned a number of points, and the sum of these points will give a patient-level multimorbidity score. We will internally validate our indices using bootstrapping techniques, and externally validate them in a cohort of older adults from the National Health and Aging Trends Study. Throughout this process, we will consult with a group of expert advisors to ensure that we develop our measures in a manner that is maximally useful to researchers and health systems leaders. Relevance / public health significance: Improved measures of multimorbidity that reflect patient-centered outcomes will be crucial tools for clinical epidemiology, health services research, and clinical programs that seek to improve care for older adults.