Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries.
Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries.
复制标题
DOI：
10.1016/j.pmrj.2017.04.005
复制
发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Bogner HR
中科院分区：
文献类型：
--
作者：
Kurichi JE;Kwong PL;Xie D;Bogner HR
预测模型可以帮助临床医生为患者提供最佳和最适当的护理，并可以帮助政策制定者为最有可能出现不良结局的群体设计服务。其目的是开发预测模型，识别功能恶化，机构化和死亡的风险因素和保护因素。队列研究使用来自医疗保险当前受益人调查（MCBS）社区调查的数据。这项研究包括21,264名65岁及以上的医疗保险受益人，他们参加了2001-2008年的MCBS，并随访了两年。该指数是在60%中得出的，并在其余40%中得到验证。使用来自多项逻辑回归模型的β系数来推导点，将其加在一起以创建与结果相关的评分。结果是进入MCBS后两年的日常生活活动（ADL）阶段过渡。受益者被分为四个结果类别之一：稳定或改善功能，功能恶化，机构，或死亡。我们的模型确定了16个功能恶化的因素在后向选择后，研究人员对患者的年龄、性别、教育、生活安排、双重资格、代理使用、阿尔茨海默病/痴呆、心绞痛/冠心病、糖尿病、肺气肿/哮喘/慢性阻塞性肺病、精神/精神障碍、帕金森病、中风/脑出血、听力障碍、视力障碍和基线ADL分期进行了评估（p<.05）。与功能稳定或改善相比，功能恶化的风险范围为≤1至≥6，住院风险范围为≤4至≥22，死亡风险范围为≤3至≥16。用于预测结果的预测指数或点和评分系统可以识别老年医疗保险受益人的功能恶化，机构化和死亡的风险，并可以帮助政策制定者，临床医生和家庭成员改善对老年人的护理，并支持社区的成功老龄化。
Prediction models can help clinicians provide the best and most appropriate care to their patients and can help policy makers design services for groups at highest risk of poor outcomes. The objective was to develop prediction models identifying both risk factors and protective factors for functional deterioration, institutionalization, and death. Cohort study using data from the Medicare Current Beneficiary Survey (MCBS) Community survey. This study included 21,264 Medicare beneficiaries 65 years of age and older who participated in the MCBS from the 2001–2008 entry panels and were followed for two years. The index was derived in 60% and validated in the remaining 40%. β-coefficients from a multinomial logistic regression model were used to derive points, which were added together to create scores associated with the outcome. The outcome was activity of daily living (ADL) stage transitions over two years following entry into the MCBS. Beneficiaries were categorized into one of four outcome categories: stable or improved function, functional deterioration, institutionalization, or death. Our model identified 16 factors for functional deterioration (age, gender, education, living arrangement, dual eligibility, proxy use, Alzheimer’s disease/dementia, angina pectoris/coronary heart disease, diabetes, emphysema/asthma/chronic obstructive pulmonary disease, mental/psychiatric disorder, Parkinson’s disease, stroke/brain hemorrhage, hearing impairment, vision impairment, and baseline ADL stage) after backward selection (p<.05). Compared to stable or improved function, the risk of functional deterioration ranged from ≤1 to ≥6, ≤4 to ≥22 for the risk of institutionalization, and ≤3 to ≥16 for the risk of death. Predictive indices, or point and scoring systems used to predict outcomes, can identify elderly Medicare beneficiaries at risk of functional deterioration, institutionalization, and death and can aid policy makers, clinicians, and family members in improving care for older adults and supporting successful aging in the community.
登录
查看更多内容
影响因子：
4.2
作者：
Eum, Regina S.;Seel, Ronald T.;Glenn, Mel B.
通讯作者：
Glenn, Mel B.
影响因子：
4.4
作者：
Hochberg, Chad;Maul, Eugenio;Ramulu, Pradeep Y.
通讯作者：
Ramulu, Pradeep Y.
影响因子：
2.8
作者：
Lee, David J.;Gomez-Marin, Orlando;Caban, Alberto J.
通讯作者：
Caban, Alberto J.
影响因子：
9.9
作者：
Bjornestad, Anders;Tysnes, Ole-Bjorn;Alves, Guido
通讯作者：
Alves, Guido
影响因子：
120.7
作者：
Genther, Dane J.;Frick, Kevin D.;Chen, David;Betz, Joshua;Lin, Frank R.
通讯作者：
Lin, Frank R.