Aging in Community Health Clinics: Multimorbidity Patterns among Middle-Aged and Older Adults (ACHES)

项目摘要 多发病在老年人中很普遍，使人丧失能力，而且代价高昂。易受伤害的成年人可能会比 在生命的早期有患多病的风险，也可能经历后遗症和其他诊断 随着时间的推移，增加多发性疾病的负担。更好地了解疾病模式如何随时间变化 与个人和社区层面因素的假定相互作用推动了当前拟议的项目 这集中在脆弱成年人的健康上。这项工作将推动#年多病和老龄化领域的发展 解决关键知识差距的重要途径：(1)最常见的多发病模式是什么 在社区卫生中心(CHC)寻求治疗的患者中很常见，这些模式如何改变 随着时间的推移？(2)社区层面的因素是否缓和了多发病和健康状况不佳之间的联系？ CHC患者的结局？(3)在CHC环境中寻求护理的中老年人是否表明 与年龄相关的更快速的下降(例如，多病负担更重，多病的复杂模式) 与寻求非CHC医疗保健的同龄人相比？以及，(4)卫生保健需求和利用情况如何 中老年多发病患者的变化？我们建议的研究利用临床 来自CHC和非CHC大型网络的电子健康记录(EHR)数据。我们期待着重要的 从调查结果中获得的见解将为临床流程(工作流程、临床护理决策)和政策提供信息 通过识别预测健康状况迅速下降的多发病模式，为安全网人口提供服务。我们 提出三个目标： 目标1.确定与特定多发病相关的患病率、模式和健康结果 随着时间的推移和社会人口学因素的变化，中老年CHC患者的组合。 目标2.确定社区一级健康的社会决定因素，以缓和 中年人中的多种疾病组合与疾病进展、恶化和死亡率 和老年慢性丙型肝炎患者。 目标3.明确中老年人的多发病患病率和随时间变化的模式 在CHC寻求护理的人与在非CHC环境中寻求护理的匹配的同行相比。

Project Summary Multimorbidity among older adults is prevalent, disabling, and costly. Vulnerable adults may be at even greater risk of multimorbidity earlier in the lifespan and may also experience sequelae and additional diagnoses that increase multimorbidity burden over time. Greater understanding of how disease patterns change over time and putative interactions with individual and community-level factors motivates the current proposed project that centers on the health of vulnerable adults. This work will advance the field of multimorbidity and aging in important ways by addressing key gaps in knowledge: (1) What kinds of multimorbidity patterns are most common among patients seeking care in community health centers (CHCs) and how do these patterns change over time? (2) Do community-level factors moderate the association between multimorbidity and poor health outcomes for CHC patients? (3) Do middle-aged and older adults seeking care in CHC settings demonstrate more rapid age-related declines (e.g., greater burden of multimorbidity, complex patterns of multimorbidity) compared to their non-CHC health care seeking peers? And, (4) How do health care needs and utilization change for middle-aged and older adults with multimorbidity? Our proposed research leverages clinical electronic health record (EHR) data from large networks of CHCs and non-CHCs. We anticipate important insights from findings that will inform clinical processes (workflow, clinical care decision-making) and policies that serve safety-net populations by identifying multimorbidity patterns predictive of rapid health downturns. We propose three aims to: Aim 1. Identify the prevalence, patterns, and health outcomes associated with specific multimorbidity combinations for middle-aged and older CHC patients over time and by sociodemographic factors. Aim 2. Identify community-level social determinants of health that moderate the relationship between multimorbidity combinations and disease progression, exacerbations, and mortality among middle-aged and older CHC patients. Aim 3. Specify multimorbidity prevalence and patterns over time among middle-aged and older adults seeking care in CHC relative to matched counterparts seeking care in non-CHC settings.