Comparing clinician descriptions of frailty and geriatric syndromes using electronic health records: a retrospective cohort study.
Comparing clinician descriptions of frailty and geriatric syndromes using electronic health records: a retrospective cohort study.
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DOI：
10.1186/s12877-017-0645-7
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发表时间：
2017-10-25
期刊：
影响因子：
4.1
通讯作者：
Kharrazi H
中科院分区：
文献类型：
--
作者：
Anzaldi LJ;Davison A;Boyd CM;Leff B;Kharrazi H
老年综合征，包括虚弱，在老年人中很常见，并与不良结局相关。我们比较了临床记录中描述为“虚弱”的患者与其他老年人在老年综合征负担和医疗保健利用方面的差异。我们对18，341名65岁以上的Medicare Advantage登记者（马萨诸塞州一家大型非营利医疗组织的成员）进行了一项回顾性队列研究，分析了长达三年的行政索赔以及结构化和非结构化电子健康记录（EHR）数据。我们从索赔和EHR数据中确定了10种老年综合征（福尔斯、营养不良、痴呆、严重尿控问题、粪便控制缺失、视力障碍、行走困难、压疮、缺乏社会支持和体重减轻）的存在，并使用模式匹配自然语言处理（NLP）算法确定了临床笔记中存在的虚弱描述。在18，341名患者中，我们发现2202名（12%）在临床记录中被描述为“虚弱”。“虚弱”患者年龄较大（82.3 ± 6.8 vs 75.9 ± 5.9，p <0.001），与其他人群相比，其医疗保健利用率较高，包括住院和急诊就诊次数（p <0.001）。在所研究的10种老年综合征中，“虚弱”患者平均有4.85 ± 1.72种，而非虚弱患者有2.35 ± 1.71种（p = 0.013）。福尔斯、行走困难、营养不良、体重减轻、缺乏社会支持和痴呆与虚弱描述的相关性更高。“虚弱”患者中最常见的老年综合征模式是行走困难、缺乏社会支持、福尔斯和体重减轻的组合。在临床记录中被提供者确定为“虚弱”的患者比其他患者有更高的医疗保健利用率和更多的老年综合征。某些老年综合征与虚弱的描述比其他综合征的相关性更高。本文的在线版本（10.1186/s12877-017-0645-7）包含补充材料，可供授权用户使用。
Geriatric syndromes, including frailty, are common in older adults and associated with adverse outcomes. We compared patients described in clinical notes as “frail” to other older adults with respect to geriatric syndrome burden and healthcare utilization. We conducted a retrospective cohort study on 18,341 Medicare Advantage enrollees aged 65+ (members of a large nonprofit medical group in Massachusetts), analyzing up to three years of administrative claims and structured and unstructured electronic health record (EHR) data. We determined the presence of ten geriatric syndromes (falls, malnutrition, dementia, severe urinary control issues, absence of fecal control, visual impairment, walking difficulty, pressure ulcers, lack of social support, and weight loss) from claims and EHR data, and the presence of frailty descriptions in clinical notes with a pattern-matching natural language processing (NLP) algorithm. Of the 18,341 patients, we found that 2202 (12%) were described as “frail” in clinical notes. “Frail” patients were older (82.3 ± 6.8 vs 75.9 ± 5.9, p < .001) and had higher rates of healthcare utilization, including number of inpatient hospitalizations and emergency department visits, than the rest of the population (p < .001). “Frail” patients had on average 4.85 ± 1.72 of the ten geriatric syndromes studied, while non-frail patients had 2.35 ± 1.71 (p = .013). Falls, walking difficulty, malnutrition, weight loss, lack of social support and dementia were more highly correlated with frailty descriptions. The most common geriatric syndrome pattern among “frail” patients was a combination of walking difficulty, lack of social support, falls, and weight loss. Patients identified as “frail” by providers in clinical notes have higher rates of healthcare utilization and more geriatric syndromes than other patients. Certain geriatric syndromes were more highly correlated with descriptions of frailty than others. The online version of this article (10.1186/s12877-017-0645-7) contains supplementary material, which is available to authorized users.
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影响因子：
2.5
作者：
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通讯作者：
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影响因子：
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DOI：
10.1097/spv.0000000000000165
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DOI：
10.1016/j.jamda.2013.03.022
发表时间：
2013-06
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Morley JE;Vellas B;van Kan GA;Anker SD;Bauer JM;Bernabei R;Cesari M;Chumlea WC;Doehner W;Evans J;Fried LP;Guralnik JM;Katz PR;Malmstrom TK;McCarter RJ;Gutierrez Robledo LM;Rockwood K;von Haehling S;Vandewoude MF;Walston J
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