Study On The Construction Of Multimorbidity Risk Assessment Model And Health Management Service Path For Middle-aged And Older Adults In The Community

Objectives:China’s State Council has released a plan for the development of the country’s elderly care services system during the 14th Five-Year Plan period(20212025),which specifies the need to develop unified,standardized,and operable assessment tools,and to strengthen early screening,intervention,and classification guidance for key chronic diseases in the elderly population.The purpose of this study is to construct key technologies in health management services and to provide primary care providers with intervention and classification guidance programs for multimorbidity,to achieve early screening and intervention of multimorbidity in middle-aged and older adults in the community.This will reduce the incidence of multimorbidity and improve the health level and quality of life of middle-aged and older adults.Methods:Based on the articles related to multimorbidity published in "Web of Science" and "CNKI",we used CiteSpace software to draw the keyword co-occurrence network,the co-citation network,and the national publication mapping to visualize and analyze the dynamic evolution trajectory and frontier changes in the field of multimorbidity globally and in China.The data for the construction of the multimorbidity risk assessment model was sourced from CHARLS.According to the purpose of the study,the sample aged 45 years and who participated in the follow-up survey from 2011 to 2018 was selected.Demographic characteristics,multimorbidity,modifiable lifestyles and depression were included in the risk assessment model.The middle-aged and elderly people included in the study were randomly divided into a training set and a validation set according to 8:2,and a Cox proportional hazards regression model was fitted to estimate the risk factors of multimorbidity.A nomogram model was formulated based on the results of the multivariable cox proportional hazard model in the training set,which is the final multimorbidity risk assessment model.The accuracy of the risk assessment model is measured by the C-index,and the calibration degree is shown by the Hosmer-Lemeshow test and calibration curve.Risk stratification of multimorbidity was performed by using X-tile software.Based on the behavior change wheel model,literature research,interview and focus group discussion methods were used to formulate the health management services path of multimorbidity for middle-aged and older adults in the community,and to select the intervention functions and behavior change techniques.Evaluate and modify the constructed service path by the expert consultation method.Results:Literature research in the field of multimorbidity has found that patients with multimorbidity especially the elderly,have higher utilization rates of health services and cause more economic burdens,posing challenges to global health services and the prevention and treatment of multimorbidity in our country.While overseas guidelines for the treatment of multimorbidity and community intervention programs have been explored,no scholars in China have proposed effective programs for multimorbidity interventions or health services.Findings from the multimorbidity influencing factors study showed that older age,female gender,having one chronic disease,smoking,alcohol use,and higher depression scores were associated with an increased risk of multimorbidity,sleeping,physical activity,and educational background were associated with a reduced risk of multimorbidity.Based on the analysis of influencing factors,this study constructed the first multimorbidity risk assessment model that can be self-tested at home.The verification results of the model show that the c-index of the training set and the verification set are 0.700 and 0.692 respectively,and the Hosmer lemeshow test shows that P>0.05.According to the risk assessment results,the risk of multimorbidity of the population can be divided into three levels:high(≥176.94),medium(119.21-176.93),and low(≥119.20).Finally,a multimorbidity health management service path for middle-aged and older adults in the community,including the implementation of health management,health monitoring,evaluation,and intervention,as well as the recommended intervention functions and specific behavior change techniques,has been constructed and passed the feasibility evaluation by experts.Conclusions:Based on a comprehensive review of the field of multimorbidity,this study found that behaviors are controllable factors of multimorbidity,and we constructed a self-tested risk assessment model of multimorbidity.The risk assessment model consisted of demographic characteristics,modifiable behaviors,lifestyles,and depression scores,which provides technical support for early screening of multimorbidity.At the same time,the study developed the path of multimorbidity health management services for middle-aged and older adults in the community and the technical suggestions for behavior change,which provides a theoretical and practical guide for primary care providers to carry out multimorbidity health management and can improve their capacity of health services.