Using claims data to predict dependency in activities of daily living as a proxy for frailty
Using claims data to predict dependency in activities of daily living as a proxy for frailty
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DOI：
10.1002/pds.3719
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发表时间：
2015-01-01
影响因子：
2.6
通讯作者：
Stuermer, Til
中科院分区：
文献类型：
--
作者：
Faurot, Keturah R.;Funk, Michele Jonsson;Stuermer, Til
在以人群为基础的研究中，使用行政卫生保健声明评估药物在老年人中的有效性和安全性可能会受到脆弱性导致的不可测量混杂因素的阻碍。一个基于索赔的算法，确定患者可能是依赖，脆弱的代理，可能会改善混淆控制。我们的目标是开发一种算法来预测依赖的日常生活活动（ADL）在一个样本的Medicare beneficiaries. MethodsCommunity居住的受访者2006年医疗保险当前beneficiaries调查，> 65岁，与医疗保险A部分，B，家庭健康，临终关怀索赔。ADL依赖定义为需要帮助洗澡，吃饭，走路，穿衣，散步或转移。潜在的预测因素是人口统计学、国际疾病分类、第九次修订版临床改良诊断/程序和脆弱相关疾病的耐用医疗设备代码。多因素Logistic回归分析用于预测ADL依赖性。考克斯模型估计死亡的风险比作为观察和预测的ADL dependency.ResultsOf 6391受访者的函数，57%是女性，88%白色，38%是80。ADL依赖的发生率为9.5%。ADL依赖的强预测因子是家庭病床（OR=5.44，95%CI=3.28-9.03）和轮椅（OR=3.91，95%CI=2.78-5.51）的费用。最终模型的c统计量为0.845。模型预测的ADL依赖性为20%或更高与死亡的风险比为3.19（95%CI：2.78，3.68）。ConclusionsAn算法预测ADL依赖性使用医疗保健索赔开发来衡量某些方面的脆弱。考虑老年人虚弱程度的差异可能会得出有关治疗使用、安全性和有效性的更有效结论。版权所有（c）2014约翰威利父子有限公司
PurposeEstimating drug effectiveness and safety among older adults in population-based studies using administrative health care claims can be hampered by unmeasured confounding as a result of frailty. A claims-based algorithm that identifies patients likely to be dependent, a proxy for frailty, may improve confounding control. Our objective was to develop an algorithm to predict dependency in activities of daily living (ADL) in a sample of Medicare beneficiaries.MethodsCommunity-dwelling respondents to the 2006 Medicare Current Beneficiary Survey, >65years old, with Medicare Part A, B, home health, and hospice claims were included. ADL dependency was defined as needing help with bathing, eating, walking, dressing, toileting, or transferring. Potential predictors were demographics, International Classification of Diseases, Ninth Revision Clinical Modification diagnosis/procedure and durable medical equipment codes for frailty-associated conditions. Multivariable logistic regression was used to predict ADL dependency. Cox models estimated hazard ratios for death as a function of observed and predicted ADL dependency.ResultsOf 6391 respondents, 57% were female, 88% white, and 38% were 80. The prevalence of ADL dependency was 9.5%. Strong predictors of ADL dependency were charges for a home hospital bed (OR=5.44, 95%CI=3.28-9.03) and wheelchair (OR=3.91, 95%CI=2.78-5.51). The c-statistic of the final model was 0.845. Model-predicted ADL dependency of 20% or greater was associated with a hazard ratio for death of 3.19 (95%CI: 2.78, 3.68).ConclusionsAn algorithm for predicting ADL dependency using health care claims was developed to measure some aspects of frailty. Accounting for variation in frailty among older adults could lead to more valid conclusions about treatment use, safety, and effectiveness. Copyright (c) 2014 John Wiley & Sons, Ltd.