Multimorbidity Among People with Serious mental illness (MAPS): Mapping disease clusters, risk factors, trajectories, service barriers and outcomes

在一般人群中，许多长期病症对健康、卫生保健的使用和费用以及预期寿命的影响已得到充分了解，人们认识到这种“多重疾病”的负担会导致较差的健康结果。然而，对于多重长期精神和身体状况如何影响严重精神疾病（SMI）患者，人们知之甚少。尽管存在公认的“死亡率差距”，与一般人群相比，重度精神分裂症患者往往在更年轻的时候死亡。这意味着至关重要的是要了解不同的组合，或疾病的“集群”，例如心脏病或呼吸系统疾病，可能会影响重度精神障碍患者，了解由于这种“疾病负担”，谁可能面临最大的风险，以及如何支持他们。在本工作方案中，我们将汇集掌握重度精神障碍患者健康和疾病的许多方面的大型数据集，以确定重度精神障碍患者的长期状况集群，确定导致这些分组的风险因素，并了解它们对健康和疾病以及无家可归等更广泛问题的影响。这项工作的目标是帮助开发提供护理的改进方法并缩小死亡率差距。通过与服务使用者、卫生专业人员和决策者合作，我们将确定如何将我们对这些“群组”的理解转化为改善服务、改善护理并帮助减少疾病风险和负担的行动。为此，我们将1)总结和检查关于这一主题的所有现有证据，以帮助我们提出潜在的疾病分组、患病率和结果。然后，我们将使用重度精神障碍患者的医疗记录来了解这些患者如何使用医疗保健，他们所属的疾病分组，以及某些风险因素是否对某些人的影响比对其他人的影响更大，并随着时间的推移跟踪人们，以了解谁更有可能住院或死亡。我们还将与重度精神障碍患者进行访谈，以更深入地了解他们对医疗保健系统的使用情况，他们在NHS的经历，他们是如何随着时间的推移获得长期疾病的，他们在多种健康状况下的生活经历，他们的生活状况如何影响他们的健康，以及他们需要什么帮助。最后，我们将把所有的研究结果结合起来，以确定这些疾病分组对患者和服务意味着什么，并找到改进NHS为这些分组中的患者提供护理的方法。这将包括改善护理途径，既帮助“集群”内的现有服务用户，又帮助规划通过加强预防减少最终患有多种疾病的人数的方法。在整个工作方案中，服务使用者将在发展研究、帮助解释和传播研究结果以及共同制定改善护理的解决办法方面发挥不可或缺的作用。这项研究将在许多层面上产生影响。它将通过更好地了解谁的风险最大，为国民保健服务系统的卫生保健专业人员提供信息，以帮助预防重度精神障碍患者中多种长期疾病的发展。通过认识到不同的“集群”有不同的需求，它将帮助NHS了解如何改善对患有许多长期疾病的重度精神障碍患者的护理。这项工作的核心目标是改善重度精神分裂症患者的生活，通过提高对这一群体多重疾病负担的理解，并确定减轻这种负担的方法，支持患有复杂疾病组合的人，并帮助他们活得更长、更健康。

The impact of having many long-term conditions on health, use of health care and costs, and life expectancy is well understood in the general population, where this burden of "multimorbidity" is recognised as leading to poorer health outcomes. However, far less is known about how having multiple long-term conditions, both mental and physical, affects people with serious mental illness (SMI). This is despite there being a recognised 'mortality gap', where people with SMI tend to die at younger ages compared to the general population. This means it is vital to understand how having different combinations, or 'clusters' of illnesses for example cardiac diseases or respiratory diseases, might affect people with SMI, to understand who may be most at risk due to this 'disease burden' and how they can be supported. In this programme of work, we will bring together large data sets that capture many aspects of health and illness for people with SMI, to identify clusters of long-term conditions among people with SMI, identify the risk factors that contribute to these groupings, and understand their impacts on both health and illness, as well as on broader problems such as homelessness. The goal of this work is to help develop improved ways of delivering care and decrease the mortality gap. By working with service users, health professionals and policy makers, we will identify how our understanding of these 'clusters' can be translated into actions that improve service, lead to better care, and help reduce the risk and burden of illness. To do this, we will 1) summarise and examine all existing evidence on this topic to help us come up with potential disease groupings, prevalence and outcomes. We will then 2) use health care records from people with SMI to understand how these patients use health care, the disease groupings they belong to, and whether certain risk factors affect some people more than others, as well as follow people over time to understand who is more at risk of being hospitalised or dying. We will also 3) hold interviews with people with SMI to understand in more depth their use of the health care system, their experiences with the NHS, how they acquired their long-term conditions over time, the experience of living with multiple health conditions, how their living situation affects their health and what help they would have needed. Finally, we will 4) combine all the findings to agree what these disease groupings mean for patients and services and find ways to improve how the NHS delivers care for patients in these groupings. This will include improving care pathways that both help existing service users within the 'clusters' and help to plan ways to reduce the number of people who end up with multiple illnesses, through enhanced prevention. Throughout the programme of work, service users will play an integral role in developing the research, helping to interpret and disseminate findings and co-producing solutions for improved care.This research will have an impact on many levels. It will provide NHS health care professionals with information to help prevent the development of multiple long-term conditions among people with SMI, by better understanding who is most at risk. It will help the NHS understand how to improve the care of people with SMI who have many long-term conditions, by recognising how different 'clusters' have different needs. The core goal of this work is to improve the lives of people with SMI, by improving understanding of the burden of multimorbidity for this group and identifying ways to decrease that burden, support people living with complex combinations of illness, and help people live longer and healthier lives.