Promoting health and preventing disease in disadvantaged urban neighborhoods

项目摘要 本申请响应SIP 13 -072，扩展有关痴呆症和并发症的信息 老年人的慢性病，将为临床医生，政策制定者和 研究人员建立/完善指导方针和目标干预措施，以提高老年人的护理质量 认知障碍（CI）和多种慢性疾病（MCC）。它将解决主要的研究差距， 以前通过SIP 10-037确定的公共卫生实践信息和其他潜在的优先领域， 疾病预防控制中心国家慢性病预防和健康计划中心的健康老龄化计划， 人口保健司，即，“多种慢性病”、“提供临床预防 服务”和“服务利用结果-住院。" 第一部分是对健康和退休研究/医疗保险组合的二次分析。 行政数据库，以衡量传播和信息及千年挑战对收到必要和预防性援助的影响。 护理和非卧床护理敏感的住院治疗。它将解决早期研究的几个具体局限性 关于CI和MCC患者使用卫生服务的问题：重点关注过度使用或使用不足，而不是护理质量; 关注单一慢性病而不是MCC; MCC;未能检查NPC对其他服务使用的影响;无法检查CI水平。 第二部分包括利用专家小组指导的文献审查和公共政策议程 发展战略建议与选定的健康老龄化研究网络中心合作， 特别专长/专注于CI，生物行为心脏健康（B2 H2）合作，国际 多形态研究社区和CDC项目科学家。 第一部分的目标：在全国具有代表性的65岁及以上成年人样本中： 目标1：提供基线描述性统计数据，确保目标2和目标3遵循SMART原则， 测量CI和MCC的发生和共同发生：CI的一年期患病率（无，轻度， 中度/重度）和慢性疾病，使用计数、已发表的指数、合并症的交叉， 老年综合征和身体残疾，以及经验得出的合并症集群;目的2：在一个交叉- 截面分析，比较NPC和H-ACS在有和没有MCC的个体中的使用（测量为 目的3：测试模型以检查是否接受了治疗（如上文所示）和/或患有轻度或中度/重度CI;目的3：测试模型以检查是否接受了治疗（如上文所示）和/或患有轻度或中度/重度CI。 NPC不足介导MCC和/或CI与H-ACS的可能性较高之间的关系。 第二部分目标 目标1：进行有指导的文献综述，以更新SIP 10-037中关于知识差距的发现 关于老年人MCC;目标2：召集并聘请5-8名成员组成的专家小组， 传播健康老龄化研究网络的公共卫生议程。

PROJECT ABSTRACT This application in response to SIP13-072, Expanding Information about Dementia and Co-occurring Chronic Conditions among Older Adults, will provide critical information to clinicians, policy makers and researchers to establish/refine guidelines and target interventions to improve quality of care for older adults with cognitive impairment (CI) and multiple chronic conditions (MCC). It will address major research gaps in public health practice information previously identified through SIP 10-037 and other potential priority areas of the Healthy Aging Program in the CDC's National Center for Chronic Disease Prevention and Health Program, Division of Population Health, viz., "multiple chronic conditions", "provision of clinical preventive services" and "service utilization outcomes-hospitalizations." Component One consists of a secondary analysis of the combined Health and Retirement Study/Medicare administrative data database to measure the impact of CI and MCC on receipt of necessary and preventive care and ambulatory-care-sensitive hospitalizations. It will address several specific limitations of earlier studies on health services use by persons with CI and MCC: focus on over- or under-use rather than quality of care; focus on single chronic conditions rather than MCC; simplistic conceptualization and operationalization of MCC; failure to examine the impact of NPC on other service utilization; and inability to examine level of CI. Component Two consists of the use of an expert-panel guided literature review and public policy agenda development strategy proposing collaboration with selected Healthy Aging Research Network Centers having particular expertise in/focus on CI, the BioBehavioral Heart Health (B2H2) Collaboration, the International Research Community on Multimorbidity, and CDC Project Scientists. Component One Aims: In a nationally representative sample of adults age 65 and older: Aim 1: To provide baseline descriptive statistics and ensure that Aims 2 and 3 follow SMART principles, measure the occurrence and co-occurrence of CI and MCC as: one-year period prevalence of CI (none, mild, moderate/severe) and chronic conditions using counts, published indices, intersection of comorbidities, geriatric syndromes and physical disability, and empirically derived clusters of comorbidities; Aim 2: In a cross- sectional analysis, compare the use of NPC and H-ACS in individuals with and without MCC (measured as indicated above) and/or with mild or moderate/severe CI; Aim 3: Test a model to examine whether receipt of inadequate NPC mediates the relationship between MCC and/or CI and higher likelihood of H-ACS. Component Two Aims Aim 1: Conduct a guided literature review to update findings from SIP 10-037 regarding gaps in knowledge about MCC in older adults; Aim 2: Assemble and engage a 5-8 member expert panel to develop, vet and disseminate a public health agenda for the Healthy Aging Research Network.