Universal outcomes as a common metric across multiple diseases in elders

描述（由申请人提供）：多发性疾病使临床决策和卫生政策复杂化。多种疾病的预防、诊断和治疗负担沉重、费用昂贵，而且可能相互矛盾或有害。治疗一种疾病可能会使其他疾病恶化。此外，患有多种疾病的个体有不同的健康结果优先事项。如果没有一个共同的指标来比较、对比和/或结合不同疾病，就很难解决这些挑战和冲突。从这项探索性研究开始，这条调查线的目标是提供证据，支持将全民健康结果作为慢性病的统一重点和共同指标。本探索性研究的目的是确定疾病特异性结局是否代表了介导个体疾病对普遍健康结局影响的中间结局。主要目的是确定就个别慢性疾病而言，疾病特异性结局是否以及在多大程度上代表疾病与一种或多种普遍健康结局之间的中间结局。我们将检验这一假设，即4种疾病中每种疾病对一种或多种普遍结果的影响中，有50%是通过疾病特异性结果介导的。次要目标是确定，对于共存疾病的组合，疾病特异性结果是否以及在多大程度上介导共存疾病组合对普遍健康结果的影响（该目标通过同时考虑所有4种疾病扩展了主要目标）。我们将在两个老年人纵向队列中解决这些问题，即妇女健康与老龄化研究I和ii和心血管健康研究。慢性疾病包括：心力衰竭、痴呆、慢性肺病和关节炎。普遍的结果领域包括：1)日常生活的基本、工具和社会生产活动；2)心理功能；3)认知功能；4)症状和减值负担；5)生存/死亡。发现特定疾病的结果映射到一套普遍的健康结果，将支持普遍健康结果作为跨疾病的共同指标。如果在未来的明确研究中得到证实，这条调查线的结果最终可以为临床决策、研究和卫生政策提供信息。公共卫生相关性：多种疾病的预防、诊断和治疗负担沉重、费用昂贵，而且可能相互矛盾或有害。如果没有一个共同的指标来比较、对比和/或结合不同疾病，就很难解决这些挑战和冲突。如果特定疾病的结果映射到一组普遍的健康结果，那么这些普遍的健康结果可以作为跨疾病的共同指标，可以为临床决策、研究、质量保证和卫生政策提供信息。

DESCRIPTION (provided by applicant): Multiple morbidity complicates clinical decision-making and health policy. The prevention, diagnosis, and treatment of multiple diseases are burdensome, expensive, and potentially contradictory or harmful. Treating one disease may make other(s) worse. Furthermore, individuals with multiple diseases have varying health outcome priorities. Resolving these challenges and conflicts is difficult without a common metric to compare, contrast, and/or combine across diseases. The goal of this line of investigation, beginning with this exploratory study, will be to provide evidence supporting universal health outcomes as the unifying focus and common metric across chronic diseases. The purpose of this exploratory study is to determine whether disease-specific outcomes represent intermediates outcomes that mediate the effect of individual diseases on universal health outcomes. The primary aim is to determine, for individual chronic diseases, whether and to what extent disease-specific outcomes represent intermediate outcomes between the disease and one or more universal health outcomes. We will test the hypothesis that >50% of the effect of each of 4 diseases on one or more universal outcomes is mediated through the disease-specific outcomes. The secondary aim is to determine, for the combination of coexisting diseases, whether and to what extent disease-specific outcomes mediate the effect of the combination of coexisting diseases on universal health outcomes (this aim extends the primary aim by considering all 4 diseases together). We will address these aims in two longitudinal cohorts of older adults, the Women's Health and Aging Study I and ll and Cardiovascular Health Study. The chronic diseases include: heart failure, dementia, chronic lung disease, and arthritis. The universal outcome domains include: 1) Basic, instrumental, and social- productive activities of daily living; 2) psychological functioning; 3) cognitive functioning; 4) symptom and impairment burden; and 5) survival /death. Finding that disease-specific outcomes map unto a universal set of health outcomes would support universal health outcomes as a common metric across diseases. If verified in future definitive studies, results of this line of investigation could ultimately inform clinical decision-making, research, and health policy. PUBLIC HEALTH RELEVANCE: The prevention, diagnosis, and treatment of multiple diseases are burdensome, expensive, and potentially contradictory or harmful. Resolving these challenges and conflicts is difficult without a common metric to compare, contrast, and/or combine across diseases. If disease-specific outcomes map unto a universal set of health outcomes, then these universal health outcomes could serve as common metrics across diseases that could inform clinical decision-making, research, quality assurance, and health policy.