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

项目摘要 心力衰竭（HF）是65岁及以上成人住院的主要原因。超过3百万 住院治疗每年发生在老年HF患者中， 常见的，昂贵的，通常是可以预防的。十多年来，30天的再次入院治疗已经收到了 作为提高老年人护理质量和降低成本的可操作目标， （医疗）人口。尽管有这些投资，高（再）住院率继续使巨大的 这给美国医疗系统和那些患有这种疾病的人带来了压力。我们认为这些策略 已经在很大程度上是无效的，因为他们专注于一个病人的住院风险的单一快照（30- 日再入院），并且不考虑在疾病过程中发生的大多数住院。 因此，预测并最终降低老年人再入院率的努力将继续不足 直到住院治疗的完全停止得到承认和解决。为了满足这一迫切需要，我们 这项研究将解决三个关键的未回答的问题：什么是最常见的住院模式 发生在老年心衰患者身上的哪些患者最有可能遵循这些模式 住院？在治疗过程中，哪些因素可以帮助预防住院？ 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， 老年人，医疗保险索赔和电子健康记录，我们提出的目标有三个方面：首先，我们将 对诊断为HF的老年人的主要住院轨迹进行分类。这一目标将 提供HF患者在治疗过程中住院次数和时间变化的证据。 他们的病其次，我们将研究各种人口统计学、社会经济学、社会心理学， 行为、健康和医院相关因素与HF患者的住院模式相关。 这一目标将使我们能够确定在诊断时可以评估的关键患者特征， 预测一个人在其疾病过程中具有给定入院轨迹的概率。第三、 我们将确定在HF治疗过程中可能减少住院的因素。我们的最终目标是 检查可能改变轨迹的过程的类似的宽范围的因素（即，时间和/或次数） 住院治疗，特别是在经历大量住院治疗和/或面临 风险的关键时期。汇集了一支强大的跨学科研究团队， 该项目将有巨大的潜力，为最重要的干预措施的设计，目标和时间安排提供信息。 可能成功地减少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.