Measuring Frailty in Medicare Data: Development and Validation of a Claims-Based Frailty Index
Measuring Frailty in Medicare Data: Development and Validation of a Claims-Based Frailty Index
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DOI：
10.1093/gerona/glx229
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发表时间：
2018-07-01
影响因子：
5.1
通讯作者：
Avorn, Jerry
中科院分区：
文献类型：
--
作者：
Kim, Dae Hyun;Schneeweiss, Sebastian;Avorn, Jerry
背景：虚弱是老年人健康状况和医疗保健干预结果的关键决定因素，而医疗保险数据不易衡量这一点。本研究旨在开发和验证基于索赔的虚弱指数 (CFI)。方法：我们使用 2006 年 Medicare 当前受益人调查（开发样本：n = 5,593）和 2011 年（验证样本：n = 4,424）的数据。 CFI 是使用 2006 年索赔数据来近似基于调查的脆弱指数 (SF!)，该指数是根据 2006 年调查数据作为参考标准计算得出的。我们将 CFI 与综合合并症指数 (CCI) 在预测 2007 年死亡、残疾、反复跌倒和医疗保健利用的能力方面进行了比较。作为验证，我们使用 2011 年索赔数据计算了 CFI，以预测 2012 年的这些结果。结果：CFI 与 SFI 相关（相关系数：0.60）。在发育样本中，CFI 在预测死亡率方面与 CCI 相似（C 统计量：0.77 vs. 0.78），但在残疾、活动障碍和反复跌倒方面优于 CCI（C 统计量：0.62-0.66 vs. 0.56-0.60）。尽管这两个指数对住院天数变化的解释相似，但 CFI 在解释熟练护理机构天数变化方面优于 CCI。将 CFI 添加到年龄、性别和 CCI 中可以改善预测。在验证样本中，CFI 和 CCI 在死亡率方面表现相似（C 统计量：0.71 与 0.72）。其他结果与开发样本的结果相当。 结论：一种新颖的虚弱指数可以衡量不良健康结果的风险，而这种风险是无法使用医疗保险数据中的人口特征和传统合并症指标来量化的。
Background: Frailty is a key determinant of health status and outcomes of health care interventions in older adults that is not readily measured in Medicare data. This study aimed to develop and validate a claims-based frailty index (CFI).Methods: We used data from Medicare Current Beneficiary Survey 2006 (development sample: n = 5,593) and 2011 (validation sample: n = 4,424). A CFI was developed using the 2006 claims data to approximate a survey-based frailty index (SF!) calculated from the 2006 survey data as a reference standard. We compared CFI to combined comorbidity index (CCI) in the ability to predict death, disability, recurrent falls, and health care utilization in 2007. As validation, we calculated a CFI using the 2011 claims data to predict these outcomes in 2012.Results: The CFI was correlated with SFI (correlation coefficient: 0.60). In the development sample, CFI was similar to CCI in predicting mortality (C statistic: 0.77 vs. 0.78), but better than CCI for disability, mobility impairment, and recurrent falls (C statistic: 0.62-0.66 vs. 0.56-0.60). Although both indices similarly explained the variation in hospital days, CFI outperformed CCI in explaining the variation in skilled nursing facility days. Adding CFI to age, sex, and CCI improved prediction. In the validation sample, CFI and CCI performed similarly for mortality (C statistic: 0.71 vs. 0.72). Other results were comparable to those from the development sample.Conclusion: A novel frailty index can measure the risk for adverse health outcomes that is not otherwise quantified using demographic characteristics and traditional comorbidity measures in Medicare data.