R01AG079982
Project Grant
Overview
Grant Description
Prognostic indices for hospitalized older adults with and without Alzheimer's disease and related dementias - 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 a 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) internally validate the effectiveness of these prognostic indices; and (4) 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.
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 a 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) internally validate the effectiveness of these prognostic indices; and (4) 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.
Funding Goals
NOT APPLICABLE
Grant Program (CFDA)
Awarding / Funding Agency
Place of Performance
San Francisco,
California
941211563
United States
Geographic Scope
Single Zip Code
Related Opportunity
Analysis Notes
Amendment Since initial award the total obligations have increased 274% from $821,181 to $3,070,409.
Northern California Institute For Research And Education was awarded
Prognostic Indices Hospitalized Older Adults with without Alzheimer's Disease Related Dementias
Project Grant R01AG079982
worth $3,070,409
from National Institute on Aging in September 2023 with work to be completed primarily in San Francisco California United States.
The grant
has a duration of 4 years 8 months and
was awarded through assistance program 93.866 Aging Research.
The Project Grant was awarded through grant opportunity Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional).
Status
(Ongoing)
Last Modified 6/5/26
Period of Performance
9/1/23
Start Date
5/31/28
End Date
Funding Split
$3.1M
Federal Obligation
$0.0
Non-Federal Obligation
$3.1M
Total Obligated
Activity Timeline
Subgrant Awards
Disclosed subgrants for R01AG079982
Transaction History
Modifications to R01AG079982
Additional Detail
Award ID FAIN
R01AG079982
SAI Number
R01AG079982-1603707479
Award ID URI
SAI UNAVAILABLE
Awardee Classifications
Nonprofit With 501(c)(3) IRS Status (Other Than An Institution Of Higher Education)
Awarding Office
75NN00 NIH National Insitute on Aging
Funding Office
75NN00 NIH National Insitute on Aging
Awardee UEI
NJZEFMRACCH9
Awardee CAGE
0W774
Performance District
CA-11
Senators
Dianne Feinstein
Alejandro Padilla
Alejandro Padilla
Budget Funding
| Federal Account | Budget Subfunction | Object Class | Total | Percentage |
|---|---|---|---|---|
| National Institute on Aging, National Institutes of Health, Health and Human Services (075-0843) | Health research and training | Grants, subsidies, and contributions (41.0) | $821,181 | 100% |
Modified: 6/5/26