Aging in Community Health Clinics: Multimorbidity Patterns among Middle-Aged and Older Adults (ACHES)

项目摘要 老年人中的多发病是普遍的，致残的，昂贵的。脆弱的成年人可能会更大 在生命早期有多死亡的风险，也可能出现后遗症和其他诊断， 随着时间推移增加了多重负担。更好地了解疾病模式如何随时间变化 与个人和社区层面因素的假定相互作用激发了当前拟议的项目 关注弱势成年人的健康这项工作将推动多模态和老龄化领域的发展， 通过解决知识的关键差距，重要的途径：（1）什么样的多模态模式是最重要的 在社区卫生中心（CHC）寻求护理的患者中很常见，这些模式如何改变 随着时间的推移(2)社区水平的因素是否会缓和多发性硬化症和健康状况不佳之间的关联 CHC患者的预后如何？(3)在社区卫生中心寻求护理的中老年人是否证明 更快速的年龄相关下降（例如，多重死亡的负担更大，多重死亡的模式复杂） 与他们的非CHC寻求医疗保健的同龄人相比？（4）卫生保健需求和利用 对于患有多发性硬化症的中老年人来说，我们提出的研究利用临床 电子健康记录（EHR）数据来自大型CHC和非CHC网络。我们期待重要的 调查结果的见解将为临床流程（工作流程、临床护理决策）和政策提供信息 为安全网人口提供服务，确定可预测健康状况迅速下降的多种模式。我们 提出三个目标： 目标1.确定与特定多发性硬化症相关的患病率、模式和健康结果 随着时间的推移和社会人口统计学因素，中老年CHC患者的联合用药。 目标2.确定社区一级健康的社会决定因素，这些决定因素调节 多药联用与中年人疾病进展、加重和死亡率 老年CHC患者 目标3。说明中年和老年人中多发病率和模式随时间的变化 在社区卫生中心寻求护理相对于在非社区卫生中心环境中寻求护理的匹配同行。

Project Summary Multimorbidity among older adults is prevalent, disabling, and costly. Vulnerable adults may be at even greater risk of multimorbidity earlier in the lifespan and may also experience sequelae and additional diagnoses that increase multimorbidity burden over time. Greater understanding of how disease patterns change over time and putative interactions with individual and community-level factors motivates the current proposed project that centers on the health of vulnerable adults. This work will advance the field of multimorbidity and aging in important ways by addressing key gaps in knowledge: (1) What kinds of multimorbidity patterns are most common among patients seeking care in community health centers (CHCs) and how do these patterns change over time? (2) Do community-level factors moderate the association between multimorbidity and poor health outcomes for CHC patients? (3) Do middle-aged and older adults seeking care in CHC settings demonstrate more rapid age-related declines (e.g., greater burden of multimorbidity, complex patterns of multimorbidity) compared to their non-CHC health care seeking peers? And, (4) How do health care needs and utilization change for middle-aged and older adults with multimorbidity? Our proposed research leverages clinical electronic health record (EHR) data from large networks of CHCs and non-CHCs. We anticipate important insights from findings that will inform clinical processes (workflow, clinical care decision-making) and policies that serve safety-net populations by identifying multimorbidity patterns predictive of rapid health downturns. We propose three aims to: Aim 1. Identify the prevalence, patterns, and health outcomes associated with specific multimorbidity combinations for middle-aged and older CHC patients over time and by sociodemographic factors. Aim 2. Identify community-level social determinants of health that moderate the relationship between multimorbidity combinations and disease progression, exacerbations, and mortality among middle-aged and older CHC patients. Aim 3. Specify multimorbidity prevalence and patterns over time among middle-aged and older adults seeking care in CHC relative to matched counterparts seeking care in non-CHC settings.