Aging, comorbid conditions, and health care utilization in persons with HIV

描述：艾滋病毒患者随着年龄的增长，经历了比预期更高的非艾滋病(HANA)情况，这导致了过早的发病率和死亡率。改善这些结果的一个重要障碍是，没有全国通用的数据显示HANA的疾病状况如何影响负担沉重和昂贵的医疗保健利用率(例如，经常性住院)，以及这种情况如何随着年龄的变化而变化。解决这一障碍将使循证临床干预措施的发展成为可能，并促进政策规划。这项研究的长期目标是减少艾滋病毒老年患者不必要和昂贵的医疗保健利用和制度化。这个应用程序的目标是 迈向这一长期目标的第一步是了解年龄和选定的HANA条件(糖尿病、心血管疾病、肝脏疾病、肺部疾病和精神疾病)如何相互作用，影响关键的医疗保健利用事件。我们建议研究具有全国代表性的14个州的医疗补助患者样本，对于那些进入疗养院的患者，将医疗补助文件与疗养院最低数据集(MDS)联系起来。这一提议的中心假设是，这些HANA条件可能会加速或加剧脆弱和功能衰退，导致过早和繁重的使用和制度化。这一假设的基本原理是，与对照人群相比，艾滋病毒携带者的老龄化与更高的慢性病发病率和更高的死亡率有关，但没有文献表明我们 意识到检查虚弱和功能衰退产生的那种护理利用，或 量化年龄和共病对这一利用的影响。这项建议与 美国国立卫生研究院的使命是，它寻求为日益增长的群体--艾滋病毒老年患者--减轻疾病和残疾的负担。这项研究有三个具体目的：1)描述HIV+患者中选定的共病疾病的患病率和发生率，并描述发病率和患病率如何随年龄变化；2)计算HIV+患者中负担沉重的医疗服务利用、疗养院使用和永久疗养院安置的比率作为时间年龄的函数，并显示这种关系如何随着选定的共病条件的存在而变化；以及3)计算作为时间年龄的函数的HIV+疗养院居民的功能和认知减退率，并显示这种关系如何随着选定的共病条件的存在而变化。这种方法是创新的，因为我们使用了具有全国代表性的样本，使用了以前不适用于老龄化和艾滋病毒的卫生服务研究的方法和方法，将医疗补助和MDS数据联系起来，并开发了新的分析工具来研究感染艾滋病毒的医疗补助患者繁重的服务利用情况。这种方法意义重大，因为它可以产生关于衰老生物学机制的假设，可以指导未来的工作，还因为州和联邦政策制定者需要这些数据来规划未来的护理需求。该项目的证据将为未来分析老年患者的护理质量和成本奠定基础。 艾滋病毒携带者。

DESCRIPTION: Patients with HIV are experiencing higher than expected rates of Non-AIDS (HANA) conditions as they age that contribute to premature morbidity and mortality. An important barrier to improving these outcomes is that there are no nationally generalizable data showing how HANA conditions disease impact rates of burdensome and costly health care utilization (e.g. recurrent hospitalization), and how this changes with aging. Addressing this barrier will permit the development of evidence-based clinical interventions and facilitate policy planning. The long term goal of this research is to reduce unnecessary and costly health care utilization and institutionalization for aging persons with HIV. The objective of this application, the first step toward this long term goal, is to understand how age and selected HANA conditions (diabetes, cardiovascular disease, liver disease, pulmonary disease, and psychiatric disease) interact to affect key health care utilization events. We propose to study a 14-state, nationally representative, sample of Medicaid patients, and for those admitted to a nursing home, link the Medicaid files to nursing home Minimum Data Set (MDS). The central hypothesis of this proposal is that these HANA conditions may accelerate or accentuate frailty and functional decline, producing premature and burdensome utilization and institutionalization. The rationale for this hypothesis is that aging in persons with HIV has been associated with higher rates of chronic conditions and higher mortality than control population, but no literature that we are aware of examines the kind of care utilization that frailty and functional decline produces, or quantifies the effects of age and comorbidity on this utilization. This proposal is relevant to the NIH's mission because it seeks to reduce the burdens of illness and disability for a growing group - persons aging with HIV. This study has three Specific Aims: 1) Describe the prevalence and incidence of the selected co-morbid conditions in HIV+ persons, and describe how incidence and prevalence vary with chronologic age; 2) Calculate the rate of burdensome health care utilization, nursing home use, and permanent nursing home placement as a function of chronologic age in HIV+ persons, and show how this relationship changes with the presence of the selected co-morbid conditions; and 3) Calculate the rate of functional and cognitive decline among HIV+ nursing home residents as a function of chronological age, and show how this relationship changes with the presence of the selected co-morbid conditions. This approach is innovative because we use a nationally representative sample, employ methods and approaches from health services research not previously applied to aging and HIV, link Medicaid and MDS data, and develop new analytic tools to study burdensome service utilization in Medicaid patients with HIV. The approach is significant because it can generate hypotheses about biological mechanisms in aging that can guide future work, and also because state and federal policy makers need such data to plan for future care needs. The evidence from this project will lay the groundwork for future analyses of quality and costs of care for aging patients with HIV.