Document text
Principal Investigator: Melissa Wei
Organization: UNIVERSITY OF CALIFORNIA LOS ANGELES
Fiscal Year: 2024
Award: $611,706
Funding agency: National Institute on Aging
Project Summary / Abstract
Virtually all U.S. adults will develop multimorbidity (coexistence of multiple chronic conditions) by late
adulthood. The sequelae are substantial: vulnerability to acute illness, disease exacerbation, hospitalization,
disability, poor health-related quality of life, and mortality. Despite this, there are no viable, patient-centered
measures for multimorbidity in the electronic health record (EHR) that include a comprehensive inventory of
conditions based on their impacts on physical functioning in community-dwelling adults and are thus broadly
applicable for the general population. The absence of such tools impedes systematic efforts to develop
effective interventions for patients with multimorbidity. To bridge these gaps, this proposal aims to develop and
validate a robust, clinically relevant, readily-available EHR-based multimorbidity-weighted index (eMWI) that
accurately ascertains disease presence using EHR data and is applicable for diverse populations across the
lifespan. The central hypothesis is that a comprehensive multimorbidity index that weights conditions based on
their impacts on physical functioning can more precisely quantify multimorbidity and provide a better model fit
to predict key health outcomes than prior measures. This hypothesis is strongly supported by our preliminary
results using large national surveys and survey-linked claims data, in which we rigorously developed and
validated a comprehensive set of 91 chronic conditions weighted by their average impacts on physical
functioning over the disease life course, thus incorporating illness burden and physical functioning into a
clinically meaningful measure applicable for the general population. As a transformative step for multimorbidity
measurement in patient care, population health, and research using EHR data, the team aims to 1) improve
multimorbidity measurement by more accurately ascertaining disease cases, and merging these with validated
physical functioning disease weights to create a new patient-centered eMWI applicable to diverse populations;
2) assess the validity of eMWI via its association with key clinical outcomes: multimorbidity progression,
hospitalization, and mortality; and 3) test the applicability of eMWI to national population health and policy by
applying it to evaluate the risk of severe and fatal COVID-19 among vaccinated vs. unvaccinated adults based
on their multimorbidity. This study uses large, diverse EHR data from 6 California health systems (>6 million
adults) with unique data linkages to census data, and the largest, most nationally-representative National
COVID Cohort Collaborative (N3C) dataset (>5 million COVID cases). The results will yield a new, validated,
patient-centered multimorbidity index for EHR data – the eMWI – to help guide clinical decisions, population-
health management, policy, and research for diverse populations. The team anticipates that eMWI can directly
impact future practice and outcomes in which multimorbidity and functional status impact everyday treatment
decisions and outcomes. eMWI will be readily available in standardized code for other EHR data. Overall,
these results will improve the quality of care and health outcomes for diverse, aging adults with multimorbidity.
Terms: <21+ years old><65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><Acute><Adult><Adult Human><Advisory Committees><Affect><Age><Age Years><Aged 65 and Over><Aging><Algorithms><Biological Markers><COVID prognosis><COVID-19><COVID-19 associated death><COVID-19 associated fatality><COVID-19 associated mortality><COVID-19 death><COVID-19 fatality><COVID-19 induced death><COVID-19 induced fatality><COVID-19 induced mortality><COVID-19 mortality><COVID-19 prognosis><COVID-19 related death><COVID-19 related fatality><COVID-19 related mortality><COVID19 associated death><COVID19 associated fatality><COVID19 associated mortality><COVID19 death><COVID19 fatality><COVID19 induced death><COVID19 induced fatality><COVID19 induced mortality><COVID19 mortality><COVID19 prognosis><COVID19 related death><COVID19 related fatality><COVID19 related mortality><CV-19><California><Censuses><Chronic><Clinical><Code><Coding System><Communities><Coronavirus Infectious Disease 2019><Data><Data Linkages><Data Set><Development><Disease><Disorder><Electronic Health Record><Epidemiologic Research><Epidemiologic Studies><Epidemiological Studies><Epidemiology Research><Equipment and supply inventories><Ethnic Origin><Ethnicity><Future><General Population><General Public><Goals><Guidelines><Health><Health Care Utilization><Health Policy><Health system><Hospital Admission><Hospitalization><Immunization><Intervention><Intervention Strategies><Inventory><Investigators><Life Cycle><Life Cycle Stages><Link><Measurement><Measures><Methods><Modeling><Outcome><Patient Care><Patient Care Delivery><Patients><Phenotype><Physical Function><Policies><Policy Maker><Polypharmacy><Population><Population Heterogeneity><Population Policies><QOC><Quality of Care><Race><Races><Recommendation><Record Linkage Study><Research><Research Personnel><Researchers><Resource Allocation><Risk><Risk Adjustment><SARS-CoV-2 associated death><SARS-CoV-2 associated fatality><SARS-CoV-2 associated mortality><SARS-CoV-2 death><SARS-CoV-2 fatality><SARS-CoV-2 induced death><SARS-CoV-2 induced fatality><SARS-CoV-2 induced mortality><SARS-CoV-2 mortality><SARS-CoV-2 prognosis><SARS-CoV-2 related death><SARS-CoV-2 related fatality><SARS-CoV-2 related mortality><Standardization><Survey Instrument><Surveys><Task Forces><Testing><Vaccinated><Vaccines><Validation><Weight><above age 65><adulthood><advisory team><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><ages><bio-markers><biologic marker><biomarker><burden of disease><burden of illness><care for patients><care of patients><caring for patients><clinical care><clinical relevance><clinically relevant><co-morbid><co-morbidity><cohort><comorbidity><coronavirus disease 2019><coronavirus disease 2019 associated death><coronavirus disease 2019 associated fatality><coronavirus disease 2019 associated mortality><coronavirus disease 2019 death><coronavirus disease 2019 fatality><coronavirus disease 2019 induced death><coronavirus disease 2019 induced fatality><coronavirus disease 2019 induced mortality><coronavirus disease 2019 mortality><coronavirus disease 2019 prognosis><coronavirus disease 2019 related death><coronavirus disease 2019 related fatality><coronavirus disease 2019 related mortality><coronavirus disease prognosis><coronavirus disease-19><coronavirus disease-19 mortality><coronavirus infectious disease-19><coronavirus prognosis><cost><death due to COVID-19><death due to COVID19><death due to SARS-CoV-2><death due to coronavirus disease 2019><death due to severe acute respiratory syndrome coronavirus 2><death in COVID><death in COVID-19><death in SARS-CoV-2><death in coronavirus disease><death in coronavirus disease 2019><death in severe acute respiratory syndrome coronavirus 2><death risk><developmental><disability><disease burden><diverse populations><effective intervention><electronic health care record><electronic health data><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><epidemiologic investigation><epidemiology study><fatality due to COVID-19><fatality due to COVID19><fatality due to SARS-CoV-2><fatality due to coronavirus disease 2019><fatality due to severe acute respiratory syndrome coronavirus 2><frailty><functional status><health care management><health care policy><health care service use><health care service utilization><health data><health management><health related quality of life><healthcare management><healthcare policy><healthcare service use><healthcare service utilization><healthcare utilization><heterogeneous population><human old age (65+)><improved><improved outcome><indexing><interest><interventional strategy><life course><life span><life-threatening COVID><life-threatening COVID-19><life-threatening SARS-CoV-2><life-threatening coronavirus disease><life-threatening coronavirus disease 2019><life-threatening severe acute respiratory syndrome coronavirus 2><lifespan><mortality><mortality due to COVID-19><mortality due to COVID19><mortality due to SARS-CoV-2><mortality due to coronavirus disease 2019><mortality due to severe acute respiratory syndrome coronavirus 2><mortality risk><multimorbidity><multiple chronic conditions><non vaccinated><not vaccinated><old age><older adult><older adulthood><over 65 years><patient centered><patient oriented><poor health outcome><population diversity><population health><prognosis in COVID><prognosis in COVID-19><prognosis in COVID19><prognosis in SARS-COV-2><prognosis in coronavirus><prognosis in coronavirus disease><prognosis in coronavirus disease 2019><racial><racial background><racial origin><reduced health outcome><risk stratification><serious COVID><serious COVID-19><serious SARS-CoV-2><serious coronavirus disease><serious coronavirus disease 2019><serious severe acute respiratory syndrome coronavirus 2><severe COVID><severe COVID-19><severe COVID19><severe SARS-CoV-2><severe acute respiratory syndrome coronavirus 2 associated death><severe acute respiratory syndrome coronavirus 2 associated fatality><severe acute respiratory syndrome coronavirus 2 associated mortality><severe acute respiratory syndrome coronavirus 2 death><severe acute respiratory syndrome coronavirus 2 fatality><severe acute respiratory syndrome coronavirus 2 induced death><severe acute respiratory syndrome coronavirus 2 induced fatality><severe acute respiratory syndrome coronavirus 2 induced mortality><severe acute respiratory syndrome coronavirus 2 mortality><severe acute respiratory syndrome coronavirus 2 prognosis><severe acute respiratory syndrome coronavirus 2 related death><severe acute respiratory syndrome coronavirus 2 related fatality><severe acute respiratory syndrome coronavirus 2 related mortality><severe coronavirus disease><severe coronavirus disease 19><severe coronavirus disease 2019><severe severe acute respiratory syndrome coronavirus 2><sex><shared decision making><social deprivation><stratify risk><tool><unvaccinated><validations><virtual><weights><worse health outcome><≥65 years>