Advanced illness index: Predictive modeling to stratify elders using self-report data
Advanced illness index: Predictive modeling to stratify elders using self-report data
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DOI：
10.1089/jpm.2006.9.1310
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发表时间：
2006-12-01
影响因子：
2.8
通讯作者：
Dellapenna, Richard
中科院分区：
文献类型：
--
作者：
Brody, Kathleen K.;Perrin, Nancy A.;Dellapenna, Richard
目标：开发一个预测模型来识别未来 36 个月内死亡风险增加的人员，以便将额外的资源和评估集中在与高级护理计划相关的领域。设计：为期 3 年观察期的回顾性研究。背景：综合性非营利管理护理组织。参与者：对年度调查做出答复的 65-105 岁受益人 (n = 4888)。测量：调查工具包括身体机能、老年病学结果：11 变量模型将基线 chi(2) 从 315.71 (df = 1) 更改为 742.511 (df = 11)。正确分类的受试者率为74.3%，阴性预测值为92.2%。结论：晚期疾病指数（AII）模型稳定。使用的特征变量不容易逆转：1997年被归类为高危人群的人群在随后的几年中一直处于高危状态或死亡（1998年，92%；1999年，96%），而没有高危人群的92%在接下来的36个月内存活下来。高风险人群至少应了解他们在需要时可获得的综合家庭和社区服务的类型。它们还应该有针对性地获取治疗偏好、价值观、指定医疗保健代理、规划和高级护理指示。
Objectives: Develop a prediction model to identify persons who have an increased risk of dying within the next 36 months, in order to focus additional resources and assessment in areas related to advanced care planning.Design: Retrospective study with a 3-year observation period.Setting: Integrated, not-for-profit managed care organization.Participants: Beneficiaries aged 65-105 responding to an annual survey (n = 4888).Measurements: Survey instrument includes physical function, geriatric syndromes, health care utilization, special equipment use, self-care deficits, caregiving responsibilities, and general health problems.Results: An 11-variable model changed the baseline chi(2) from 315.71 (df = 1) to 742.511 (df = 11). The percent of subjects correctly classified was 74.3% and the negative predictive value was 92.2%.Conclusion: Advanced Illness Index (AII) model is stable. Characteristic variables used are not easily reversed: the 1997 cohort classified as at-risk consistently remained at risk or died in the subsequent years (1998, 92%; and 1999, 96%) and 92% of those not at-risk survived the next 36 months. Persons at high risk should at a minimum be made aware of the types of integrated home and community-based services available to them should it be needed. They also should be targeted for elicitation of treatment preferences, values, designation of health care proxy, planning, and advanced care directives.