A Life Course Approach to Identify Risks of Hospitalization in Older Adults with Heart Failure

项目总结 心力衰竭(HF)是65岁及以上成年人住院的主要原因。300多万 患有心力衰竭的老年人每年都会住院，出院后再次住院的人数是 常见、昂贵，而且往往是可以预防的。十多年来，30天的再次住院治疗已经收到了 将相当多的关注作为提高老年人护理质量和降低成本的可行目标 (联邦医疗保险)人口。尽管有这些投资，高(再)住院率继续使巨大的 给美国医疗体系和那些患有这种疾病的人带来压力。我们认为这些策略 在很大程度上是无效的，因为它们专注于患者住院风险的单一快照(30- 再次住院日)，不考虑在病程中发生的大多数住院治疗。 因此，预测并最终降低老年人再住院率的努力将继续不足。 直到住院的全面进展得到承认和解决。为了回应这一迫切需要，我们的 这项研究将解决三个严重悬而未决的问题：最常见的住院模式是什么 会发生在被诊断为心力衰竭的老年人身上吗？哪些患者最有可能遵循这些模式 住院治疗？哪些因素可以帮助防止在治疗过程中住院？ 从生命历程的角度出发，使用具有全国代表性的纵向研究数据 对于老年人、联邦医疗保险和电子健康记录，我们提出的目标有三个：第一，我们将 对诊断为心力衰竭的老年人的主要住院轨迹进行分类。这一目标将 提供证据，说明心力衰竭患者的住院次数和时间在 他们的病。第二，我们将考察广泛的人口统计、社会经济、心理社会、 行为、健康和医院相关因素与心力衰竭患者的住院模式相关。 这一目标将使我们能够确定关键的患者特征，这些特征可以在诊断时进行评估 预测一个人在疾病过程中有一个给定的入院轨迹的概率。第三, 我们将确定在心力衰竭治疗过程中可能减少住院率的因素。我们的最终目标是 检查可能改变轨迹轨迹(即，时间和/或数量)的类似广泛的因素 住院治疗，特别是在经历了大量住院和/或面对 风险的关键时期。汇集了一支强大的跨学科调查团队，这一结果 项目将具有巨大的潜力，可以为大多数干预措施的设计、目标和时机提供信息 有可能成功地减轻老年人住院的重大负担。

PROJECT SUMMARY Heart failure (HF) is the leading cause of hospitalization in adults aged 65 and older. More than 3 million hospitalizations occur each year in older adults with HF and recurrent hospitalizations after discharge are common, costly, and often preventable. For more than a decade, 30-day hospital readmissions have received considerable attention as an actionable target to improve quality of care and reduce costs in the older-adult (Medicare) population. Despite these investments, high rates of (re)hospitalization continue to put enormous strain on the U.S. healthcare system and on those suffering from the disease. We argue that these strategies have been largely ineffective because they focus on a single snapshot of a patient’s risk of hospitalization (30- day readmission) and do not consider the majority of hospitalizations that occur over the course of the illness. Therefore, efforts to predict and ultimately lower hospital readmissions in older adults will continue to fall short until the full progession of hospitalizations are recognized and addressed. In response to this urgent need, our study will address three critically unanswered questions: What are the most common patterns of hospitalization that occur in older adults diagnosed with HF? Who are the patients most likely to follow these patterns of hospitalization? And what are the factors that can help prevent hospitalizations during the course of treatment? Drawing from a life course perspective and using data from a nationally-representative longitudinal study of older adults, Medicare claims, and electronic health records, our proposed aims are threefold: First, we will classify the major trajectories of hospitalization that occur in older adults diagnosed with HF. This aim will provide evidence of how the number and timing of hospitalizations vary among HF patients over the course of their illness. Second, we will examine how a wide array of demographic, socioeconomic, psychosocial, behavioral, health-, and hospital-related factors are associated with patterns of hospitalization in HF patients. This aim will allow us to determine key patient characteristics that can be assessed at the time of diagnosis to predict a person’s probability of having a given trajectory of admissions over the course of their illness. Third, we will identify factors that may reduce hospitalizations during the course of HF treatment. Our final aim will examine a similarly wide range of factors that may alter the course of a trajectory (i.e., timing and/or number) of hospitalizations, particularly among patients who experience high numbers of hospitalizations and/or face critical periods of risk. Bringing together a strong team of interdisciplinary investigators, the results from this project will have enormous potential to inform the design, targeting, and timing of interventions that are most likely to succeed in reducing the significant burden of hospitalizations in older adults.