Assessment of Frailty Phenotype and Functional Limitations to Improve Prediction of Subsequent Health Care Utilization in Older Community-Dwelling Adults

年，随着年龄的增长，医疗保健负担明显增加，表现为更高的卫生保健利用率 部分原因是多种慢性疾病(多发病)的患病率增加。虽然多发性疾病是一种 更高的医疗保健负担的强大风险因素，目前的多发病措施仅解释了适度的 后续医疗费用变动的比例。为了在没有医疗负担的情况下限制医疗负担 对健康结果产生负面影响，提高对卫生保健利用的关键决定因素的了解 在老年人中是必不可少的。来自其他领域的风险因素(包括可能可更改的决定因素) 将加强对可能需要昂贵护理的居住在社区的老年人的识别。因此，模型的 卫生保健利用率，包括潜在的可修改(但不是在临床环境中常规测量) 脆弱表型的范围和自我报告的功能限制可能会改善患者的特征 风险概况，从而改进目标和干预措施的设计，以减少后续的卫生保健 负担。该提案的总体目标是构建可解释的、可概括的和有效的 确定临床风险的老年社区居住成年人的医疗费用和利用模式 有利于采取有针对性的干预措施的因素，以降低随后广泛和昂贵的卫生保健的风险。我们 将利用社区居住参与者之间的联系，对老年人进行四项队列研究 成人(骨质疏松性骨折研究[SOF]；男性骨质疏松性骨折研究[MROS]；健康老龄化和 身体成分研究[健康ABC]；和国家健康和老龄化趋势研究[NHATS])及其 联邦医疗保险索赔数据。我们将对关键的潜在临床风险因素(脆弱性)进行全面评估 表型、自我报告的功能限制以及脆弱表型和功能限制的组成部分) 对于更高的医疗保健成本和利用率，在考虑到人口统计和基于索赔的指标后 多发病和虚弱。我们的应用与NIA的使命一致，即进行生物、临床、 与衰老相关的疾病和状况相关的行为、社会和经济研究 进程。我们的研究结合了来自四个大型流行病学研究的广泛数据，利用了 以一种有效的方式对这些群体进行管理。如果我们的假设得到证实，我们的分析结果将会更多 准确描述居住在社区的老年人中面临高强度、高成本医疗保健风险的人群； 惠及医疗保健系统/支付者估计旨在延缓进展的干预措施的成本与收益 脆弱和残疾；支持对脆弱表型、功能状态或特定个体的评估 这些领域在门诊初级保健实践环境中的组成部分；并指导未来的设计 有针对性的干预试验，旨在降低老年人口的医疗保健成本和利用率。

Health care burden as manifested by greater health care utilization rises markedly with advancing age due in part to increasing prevalence of multiple chronic medical conditions (multimorbidity). While multimorbidity is a robust risk factor for higher health care burden, current multimorbidity measures explain only a modest proportion of the variation in subsequent health care costs. In order to constrain health care burden without negatively impacting health outcomes, improved understanding of key determinants of health care utilization among older adults is essential. Risk factors from other domains (including potentially modifiable determinants) would enhance identification of older community-dwelling adults likely to require costly care. Thus, models of health care utilization including the potentially modifiable (but not routinely measured in clinical settings) domains of the frailty phenotype and self-reported functional limitations may improve characterization of patient risk profiles and therefore improve targeting and design of interventions to reduce subsequent health care burden. The overarching objective of this proposal is to construct interpretable, generalizable and validated models of health care costs and utilization among older community dwelling adults that identify clinical risk factors amenable to targeted interventions to reduce risk of subsequent extensive and costly health care. We will take advantage of the linkage between community-dwelling participants in four cohort studies of older adults (Study of Osteoporotic Fractures [SOF]; Osteoporotic Fractures in Men Study [MrOS]; Health Aging and Body Composition Study [Health ABC]; and National Health and Aging Trends Study [NHATS]) and their Medicare claims data. We will perform a comprehensive evaluation of key potential clinical risk factors (frailty phenotype, self-reported functional limitations and components of frailty phenotype and functional limitations) for higher health care costs and utilization, after accounting for demographics and claims-based indicators of multimorbidity and frailty. Our application is consistent with the NIA mission to conduct biological, clinical, behavioral, social, and economic research related to the diseases and conditions associated with the aging process. Our study combines a wide range of data from four large epidemiologic studies leveraging the value of these cohorts in an efficient manner. If our hypotheses are confirmed, findings from our analyses will more accurately characterize subsets of older community-dwelling adults at risk for intense, costly health care; benefit health care systems/payers estimating costs vs. benefits of interventions aimed at delaying progression to frailty and disability; support assessment of the frailty phenotype, functional status, or specific individual components of these domains in the outpatient primary care practice setting; and direct the design of future targeted intervention trials aimed at reducing health care costs and utilization among the aged population.