Prognostic Indices for Hospitalized Older Adults with and without Alzheimer’s Disease and Related Dementias

项目总结/摘要 我们将开发和外部验证基于电子健康记录（EHR）的预后指标，以改善 通过确定最有可能符合（并受益于） 具体的卫生服务。我们的指数将预测：1）6个月死亡率，以指导临终关怀转诊决策; 2)2年死亡率，以指导门诊姑息治疗转诊和告知药物处方。我们将 为患有和不患有阿尔茨海默病和相关痴呆症的患者制定这些指数，因为 先前的研究表明，老年人患和不患阿尔茨海默病的下降轨迹不同 疾病和相关的痴呆症。功能对于老年人的预测至关重要，特别是那些 与阿尔茨海默病和相关痴呆症，我们已经表明，功能的预后能力， 随着年龄增长。一个主要的局限性，阻碍了预测指标的有效性，住院 老年人一直缺乏EHR的功能数据。最近，认识到功能的关键作用， 为老年人提供高质量的医疗保健，医院系统已经开始定期评估， 记录功能状态。这一发展有利于我们的建议，因为我们现在可以访问例行的 从几家医院的功能数据，使我们能够将这些数据纳入预后指数。关于EHR 在医疗保健系统中无处不在，我们的外部验证指数可以集成到EHR中 在大多数医院。为了方便在没有整合电子健康记录的医院使用，我们将开发简约的索引 (also对于ADRD和非ADRD患者）可在ePrognosis上获得，我们的免费和广泛使用的在线 老年预测指数简编。我们将建立一个新的标准，公平意识的预测模型 通过将"公平"纳入模型选择并将邻里劣势作为预测因素来构建 代表健康的社会决定因素。我们建立了4个研究中心的合作实验室， 收集身体功能数据、临床诊断、标准化谵妄评估、实验室值，以及 生理指标：加州大学旧金山分校和克利夫兰诊所（发展队列）;和贝丝以色列女执事医疗 中心和约翰霍普金斯（外部验证队列）。我们建议：（1）发展完整的预后指标 旨在嵌入EHR中，用于住院老年人的6个月和2年死亡率， 没有阿尔茨海默病和相关痴呆症;（2）开发基于网络的简约预后指数 设计用于通过ePrognosis访问老年人的6个月和2年死亡率， 阿尔茨海默病和相关痴呆;（3）内部验证这些预后的有效性 （4）对这些指标进行外部验证。这些指数将帮助临床医生改善医疗保健 通过促进患者预后与卫生服务（即临终关怀和 姑息治疗转诊）和取消处方的决定。

Project Summary/Abstract We will develop and externally validate electronic health record (EHR)-based prognostic indices to improve healthcare quality for hospitalized older adults by identifying patients most likely to qualify for (and benefit from) specific health services. Our indices will predict: 1) 6-month mortality to guide hospice referral decisions; and 2) 2-year mortality to guide outpatient palliative care referrals and inform medication deprescribing. We will develop each of these indices for patients with and without Alzheimer’s disease and related dementias, since previous studies suggest that the trajectory of decline differs between older adults with and without Alzheimer’s disease and related dementias. Function is critically important to prediction in older adults, particularly those with Alzheimer’s disease and related dementias, and we have shown that the prognostic power of function increases with age. A major limitation that has hindered the effectiveness of predictive indices for hospitalized older adults has been the lack of functional data in the EHR. Recently, recognizing the critical role of function in providing high quality healthcare to older adults, hospital systems have started to routinely assess and document functional status. This development facilitates our proposal since we now have access to routine functional data from several hospitals, allowing us to incorporate these data into prognostic indices. With EHRs becoming ubiquitous in healthcare systems, our externally validated indices could be integrated into the EHR in most hospitals. To facilitate use in hospitals without EHR integration, we will develop parsimonious indices (also for ADRD and non-ADRD patients) available on ePrognosis, our free and widely used online compendium of geriatric prediction indices. We will set a new standard for equity-conscious prognostic model building by “baking equity” into model selection and incorporating neighborhood disadvantage as predictor representing social determinants of health. We have established a 4 site Collaboratory, which all routinely collect physical function data, clinical diagnoses, standardized delirium assessments, laboratory values, and physiologic measures: UCSF & Cleveland Clinic (development cohort); and Beth Israel Deaconess Medical Center & Johns Hopkins (external validation cohort). We propose to: (1) Develop full prognostic indices designed to be embedded in EHRs for 6-month and 2-year mortality for hospitalized older adults with and without Alzheimer’s disease and related dementias; (2) Develop parsimonious web-based prognostic indices designed to be accessed through ePrognosis for 6-month and 2-year mortality for older adults with and without Alzheimer’s disease and related dementias; (3) To internally validate the effectiveness of these prognostic indices; and (4) to externally validate these indices. These indices will help clinicians improve healthcare quality for older adults by prompting alignment of patient prognosis with health services (i.e. hospice and palliative care referrals) and deprescribing decisions.