A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality Among Medicare Beneficiaries.
A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality Among Medicare Beneficiaries.
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DOI：
10.1097/phm.0000000000000942
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发表时间：
2018-10
影响因子：
3
通讯作者：
Bogner HR
中科院分区：
文献类型：
--
作者：
McClintock HF;Kurichi JE;Kwong PL;Xie D;Stineman MG;Bogner HR
我们试图开发一个风险评分系统，用于预测功能恶化、机构化和死亡率。确定健康状况不佳的预测因素为临床决策、服务提供和政策制定提供信息，以满足健康状况不佳风险最大的人群的需求。对21，257名年龄在65岁及以上的社区居住医疗保险受益人进行的队列研究，这些受益人参加了2001-2008年医疗保险当前受益人调查。在60%的样本中进行了模型推导，并在其余40%中进行了验证。多项逻辑回归模型生成β系数，用于创建风险评分系统。我们的结果是工具性日常生活活动阶段过渡（稳定/改善功能和功能恶化），机构化，或死亡率超过两年的随访。共确定了18个功能恶化因素（p<0.05）。在衍生队列中，与功能稳定/改善相比，功能恶化的可能性范围为6.27%-33.51%，机构化风险为0.07%-12.13%，死亡风险为2.13%-31.83%。一个风险评分系统预测医疗保险受益人的功能恶化，制度化，和死亡率的基础上人口统计和临床指标的风险可能是可行的开发与医疗服务的影响。
We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes. Cohort study with 21,257 community-dwelling Medicare beneficiaries aged 65 years and older who participated in the 2001–2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β-coefficients which were utilized to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality over two years of follow-up. A total of 18 factors were identified for functional deterioration (p<0.05). In the derivation cohort, the likelihood of functional deterioration ranged from 6.27%–33.51%, risk of institutionalization from 0.07%–12.13%, and risk of mortality from 2.13%–31.83%, in comparison with stable/improved function. A risk scoring system predicting Medicare beneficiaries’ risk of functional deterioration, institutionalization, and mortality based on demographic and clinical indicators may feasibly be developed with implications for healthcare delivery.