The COPD severity score: a dynamic prediction tool for health-care utilization.
The COPD severity score: a dynamic prediction tool for health-care utilization.
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DOI：
10.1080/15412550802522700
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发表时间：
2008-12
期刊：
影响因子：
2.2
通讯作者：
Eisner MD
中科院分区：
文献类型：
--
作者：
Omachi TA;Yelin EH;Katz PP;Blanc PD;Eisner MD
基于调查的COPD严重程度评分算法可能被证明对有针对性的疾病管理和风险调整有用。为此，我们试图前瞻性地验证之前已经过横断面验证的COPD严重程度评分。使用267名自行报告医生诊断为COPD的成人的人群样本，我们检查了COPD严重程度评分预测未来呼吸道住院、急诊科(ED)就诊和门诊就诊的程度。在接下来的两年中，在基线和年度基础上进行的结构化电话访谈确定了COPD严重程度评分和卫生保健利用情况。在多变量Logistic回归分析中，利用社会人口学、吸烟史和医学共病数据，建立了呼吸系统特定卫生保健利用的基本预测模型。然后，通过测试模型一致性指数的变化来评估COPD严重程度评分在此基础模型之上的附加预测价值。我们的分析表明，慢性阻塞性肺疾病严重程度评分确实增加了预测未来呼吸道住院(从80%增加到87%；p=0.03)、急诊就诊(%到82%，p=0.003)和门诊(59%到77%，p<；0.0001)的一致性指数。在另一项单独的分析中，基线严重程度评分越高，随着时间的推移，严重程度评分越差，都与所研究的每种结果都有前瞻性关联(p<；各0.05)。总而言之，COPD严重程度评分在估计未来特定于呼吸系统的卫生保健利用方面增加了预测值，并且纵向上对COPD状态随时间演变的变化作出反应。此严重程度评分可用于调整疾病严重程度或识别高危人群。
A survey-based COPD severity scoring algorithm could prove useful for targeted disease management and risk-adjustment. For this purpose, we sought to prospectively validate a COPD severity score that had previously been cross-sectionally validated. Using a population-based sample of 267 adults with self-reported physician-diagnosed COPD, we examined the extent to which this COPD severity score predicts future respiratory hospitalizations, emergency department (ED) visits, and outpatient visits. Structured telephone interviews, conducted at baseline and on an annual basis in two subsequent years, determined COPD severity scores and health-care utilization. A basic predictive model for respiratory-specific health-care utilization was developed using sociodemographics, tobacco history, and medical comorbidity data in multivariate logistic regression analysis. The added predictive value of the COPD severity score over and above this basic model was then evaluated by testing the change in model concordance indices. Our analysis demonstrated that the COPD severity score did in fact increase the concordance-index of models predicting future respiratory hospitalizations (increase from 80% to 87%; p=0.03), ED visits (64% to 82%, p=0.003), and outpatient visits (59% to 77%, p<0.0001). In a separate analysis, both a greater baseline severity score and worsening of the severity score over time were prospectively associated with each outcome studied (p<0.05 for each). In conclusion, the COPD severity score adds predictive value in estimating future respiratory-specific health-care utilization and is longitudinally responsive to evolving changes in COPD status over time. This severity score may be used to adjust for disease severity or to identify high-risk populations.
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影响因子：
4.9
作者：
Blanc, PD;Eisner, MD;Balmes, JR
通讯作者：
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