Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making

项目摘要/摘要 身体虚弱的老年人在患上与药物有关的急性疾病后，更有可能经历糟糕的健康结果 不良事件和手术。由于急性医院护理，虚弱患者的医疗费用翻了一番 对可预防疾病的护理和治疗。尽管脆弱会带来临床和社会后果，但脆弱 很少在临床实践中进行评估，而且几乎没有证据表明如何将脆弱性整合到临床护理和 人口健康管理。产生这种证据的关键一步是大规模测量脆弱性。 具有很高的准确性和效率。为了满足这一需求，研究团队最近开发并验证了 基于索赔的脆弱性指数(CFI)，可根据大量人群的医疗保险数据来衡量脆弱性 当面对面评估不可行时。此应用程序的目标是生成所需的证据 将CFI应用于基于索赔数据的研究，以脆弱性为导向的临床护理和人群健康管理 药物治疗；程序性治疗的实用临床试验；电子健康记录(EHR)--与医疗保险挂钩 医疗保健系统的数据。中心假设是，脆弱的信息将改善对老年人的照顾 通过揭示治疗效益-危害概况、成本和资源需求中有意义的差异。为了测试 这一假说，在脆弱性、药物流行病学方法方面拥有广泛专业知识的研究团队，以及 卫生服务研究将在未来5年实现以下具体目标：1)确定脆弱性 通过应用CFI改变10种治疗老年人慢性病的处方药的利弊 2014-2022年5%的联邦医疗保险随机抽样；2)确定脆弱性如何改变以下各项的好处和危害 通过将CFI应用于与两项正在进行的务实临床试验有关的医疗保险数据对老年人进行程序性治疗 外周动脉疾病血管内与外科血运重建治疗和针灸治疗与常规治疗的比较 护理慢性下腰痛；以及3)确定实施CFI到EHR-Medicare关联数据是否可以 在马萨诸塞州波士顿的一个大型医疗保健系统中预测高成本和高需求的患者。创新的 CFI的应用程序很容易扩展到基于索赔的有效性和安全性比较研究、临床 试验，以及卫生保健系统中的电子健康记录。这项研究的影响是重大的，因为临床上可操作的 这项研究产生的证据可以使药物和程序性治疗的最佳选择和健康 基于脆弱性的系统范围风险分层。最终，这些结果将加速将脆弱性整合到 常规护理和促进以脆弱为导向的临床护理和人口健康管理。

PROJECT SUMMARY/ABSTRACT Older adults with frailty are more likely to experience poor health outcomes after acute illnesses, drug-related adverse events, and surgeries. Health care costs for frail patients double due to acute hospital care, post-acute care, and treatments for preventable conditions. Despite clinical and societal consequences of frailty, frailty is rarely assessed in clinical practice and little evidence exists on how to integrate frailty to inform clinical care and population health management. The critical step to generate this evidence is to measure frailty on a large scale with high accuracy and efficiency. To address this need, the investigator team recently developed and validated a claims-based frailty index (CFI), which enables measurement of frailty from Medicare data for large populations when in-person assessment is not feasible. The objective of this application is to generate evidence needed for frailty-guided clinical care and population health management by applying CFI to claims data-based studies of drug therapy; pragmatic clinical trials of procedural therapy; and electronic health records (EHR)-Medicare linked data of a health care system. The central hypothesis is that frailty information will improve care of older adults by uncovering meaningful variations in the treatment benefit-harm profile, costs, and resource needs. To test this hypothesis, the investigator team with extensive expertise in frailty, pharmacoepidemiologic methods, and health services research will accomplish the following specific aims in the next 5 years: 1) determine how frailty changes the benefits and harms of 10 prescription drugs for chronic conditions in older adults by applying CFI to the 2014-2022 5% Medicare random sample; 2) determine how frailty changes the benefits and harms of procedural therapies in older adults by applying CFI to Medicare data linked to 2 ongoing pragmatic clinical trials of endovascular vs surgical revascularization therapy for peripheral arterial disease and acupuncture vs usual care for chronic low back pain; and 3) determine whether implementing CFI to EHR-Medicare linked data can predict high-cost and high-need patients in a large health care system in Boston, Massachusetts. The innovative applications of CFI are readily scalable to claims-based comparative effectiveness and safety studies, clinical trials, and EHR in health care systems. The impact of this research is significant because the clinically actionable evidence generated from this research can enable optimal choice of drug and procedural therapy and a health system-wide risk stratification based on frailty. Ultimately, these results will accelerate integration of frailty in routine care and facilitate frailty-guided clinical care and population health management.